Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 149999 | NY |
N | 2080P0201X | Pediatric Allergist | 149999 | NY |
NPI | 1134123854 |
---|---|
Provider Name | Dr. Muataz Jaber |
First Address | Rockville Centre, NY 11570-2917 |
Second Address | Rockville Centre, NY 11570-2917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 26/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B19724 | (02) |