Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | T2323 | TX |
NPI | 1609824481 |
---|---|
Provider Name | Dr. Sargon Bebla |
First Address | Syracuse, NY 13210-1640 |
Second Address | Syracuse, NY 13210-1640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 21/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126364 | BLUE CROSS (01) | NY |
2099796 | (05) | NY |
699354 | MVP (01) | NY |
7446428 | AETNA (01) | NY |
H28805 | (02) | NY |
J100000077 | PTAN (01) | NY |
POMCO | 161488013 (01) | NY |