Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2122201 | NY |
Y | 213ES0000X | Sports Medicine | 2122201 | NY |
NPI | 1548312051 |
---|---|
Provider Name | Dr. Nizarali Visram |
First Address | Ronkonkoma, NY 11779-5006 |
Second Address | Bellmore, NY 11710-5709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I00512 | (02) | NY |