Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 251904 | NY |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 251904 | NY |
NPI | 1033381579 |
---|---|
Provider Name | Dr. Saadia Naz Wasty |
First Address | Nesconset, NY 11767-1869 |
Second Address | Nesconset, NY 11767-1869 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2008 |
Last Update Date | 17/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03788992 | (05) | NY |