Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 25MA07544200 | NJ |
NPI | 1124075460 |
---|---|
Provider Name | Dr. Sharyar Daniel Samadi |
First Address | Maywood, NJ 07607-1335 |
Second Address | Paramus, NJ 07652-5242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 26/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H84956 | (02) | NJ |