Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 130130 | NY |
N | 208000000X | Pediatrician | 130130 | NY |
NPI | 1013905835 |
---|---|
Provider Name | Ms. Nawal Siage |
First Address | Astoria, NY 11103-4702 |
Second Address | Astoria, NY 11103-4702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 05/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01663758 | (05) | NY |
20E621 | BCBS (01) | |
E37980 | (02) |