Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 269292 | NY |
Y | 207L00000X | Anesthesiologist | 269292-1 | NY |
NPI | 1013213479 |
---|---|
Provider Name | Mr. Simon Mardakh |
First Address | Poughkeepsie, NY 12602 |
Second Address | Brooklyn, NY 11215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2011 |
Last Update Date | 06/01/2015 |