Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 188449 | NY |
N | 207RI0200X | Infectious Disease | 25MA05396400 | NJ |
NPI | 1043217185 |
---|---|
Provider Name | Isaia Avraham |
First Address | Brooklyn, NY 11234-6910 |
Second Address | Brooklyn, NY 11234-6910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 24/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01582943 | (05) | NY |
F46055 | (02) | NY |