Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 100952-05 | NY |
NPI | 1043896731 |
---|---|
Provider Name | Ghulam Qutab |
First Address | New York, NY 10027-7465 |
Second Address | Brooklyn, NY 11221-3253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2021 |
Last Update Date | 22/03/2021 |