Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 239853 | NY |
NPI | 1225073604 |
---|---|
Provider Name | Mohamed Ilyaz Gaffoor |
First Address | Brooklyn, NY 11219-2919 |
Second Address | Brooklyn, NY 11219-2918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 08/07/2007 |