Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 221818 | NY |
NPI | 1053334490 |
---|---|
Provider Name | Kevin Sano |
First Address | E Patchogue, NY 11772-4886 |
Second Address | E Patchogue, NY 11772-4886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 16/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02395953 | (05) | NY |
H83151 | (02) | NY |
P00028641 | RAILROAD MEDICARE (01) | NY |