Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 036052 | NY |
NPI | 1154522316 |
---|---|
Provider Name | Dr. Samuel Pai |
First Address | Kingston, NY 12401-3739 |
Second Address | Kingston, NY 12401-3739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 08/07/2007 |