Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 197285 | NY |
Y | 207WX0107X | Retina Specialist | 197285-1 | NY |
NPI | 1013014406 |
---|---|
Provider Name | Mark Harooni |
First Address | Brooklyn, NY 11215-1212 |
Second Address | Brooklyn, NY 11215-1212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 28/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01765333 | (05) | NY |
G11173 | (02) | NY |