Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | NY117819-1 | NY |
NPI | 1386740967 |
---|---|
Provider Name | Dr. Mohamed S Razack |
First Address | Orlando, FL 32836-5526 |
Second Address | Buffalo, NY 14214-2635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E15495 | (02) | NY |