Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 141804 | NY |
N | 111NI0900X | Internist | 141804 | NY |
Y | 207RH0000X | Hematologist | 141804 | NY |
N | 207RH0003X | Hematology & Oncology | 141804 | NY |
N | 207RH0003X | Hematology & Oncology | MA66626 | NJ |
N | 207RX0202X | Medical Oncology | 141804 | NY |
NPI | 1255306403 |
---|---|
Provider Name | Mrs. Lucy Sourial |
First Address | New York, NY 10010 |
Second Address | New York, NY 10010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 22/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00901175 | (05) | NY |
B15736 | (02) |