Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 209818 | NY |
NPI | 1003988718 |
---|---|
Provider Name | Mrs. Angela Azar |
First Address | Great Neck, NY 11023-0309 |
Second Address | Great Neck, NY 11021-4700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 16/02/2015 |