Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 047363 | NY |
NPI | 1093924755 |
---|---|
Provider Name | Mrs. Soheli Anar Azad |
First Address | Queens Village, NY 11429 |
Second Address | Jackson Heights, NY 11372 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 05/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012254 | DORAL DENTAL (01) | NY |
01831667 | (05) | NY |