Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 30-023549 | OH |
N | 122300000X | Dentist | DS039039 | PA |
Y | 1223E0200X | Endodontist | 057156 | NY |
NPI | 1073830048 |
---|---|
Provider Name | Dr. Navid Vosoughi |
First Address | New York, NY 10025-8073 |
Second Address | New Square, NY 10977-8916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2010 |
Last Update Date | 13/07/2016 |