Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 124769 | NY |
NPI | 1013986462 |
---|---|
Provider Name | Kass Sadri |
First Address | New York, NY 10028 |
Second Address | New York, NY 10028-7504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 25/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B13668 | (02) |