Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 123867 | NY |
Y | 208600000X | Surgeon | 123867 | NY |
NPI | 1003916628 |
---|---|
Provider Name | Dr. Mohammad Ansari |
First Address | Hyde Park, NY 12538-3116 |
Second Address | Pleasant Valley, NY 12569-7825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00557759 | (05) | NY |
C12528 | (02) | NY |