Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 049823-1 | NY |
Y | 213EG0000X | General Practice | 049823-1 | NY |
NPI | 1003951039 |
---|---|
Provider Name | Dr. Simona Saroyan |
First Address | Port Chester, NY 10573-3811 |
Second Address | Port Chester, NY 10573-3811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02376896 | (05) | NY |