Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 228158 | NY |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 228158 | NY |
NPI | 1851667216 |
---|---|
Provider Name | Moni Abraham Kuriakose |
First Address | Buffalo, NY 14263-0001 |
Second Address | Buffalo, NY 14263-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2012 |
Last Update Date | 15/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02442524 | (05) | NY |