Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 005083-1 | NY |
NPI | 1316970023 |
---|---|
Provider Name | Iqbal Venjara |
First Address | Brooklyn, NY 11236-4811 |
Second Address | Brooklyn, NY 11236-4811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 29/11/2007 |