Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 22DI02670100 | NJ |
Y | 1223E0200X | Endodontist | 059980 | NY |
NPI | 1114448941 |
---|---|
Provider Name | Dr. Nassim Kohly |
First Address | New York, NY 10017-5963 |
Second Address | New York, NY 10016-3892 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2017 |
Last Update Date | 03/10/2018 |