Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 058637 | NY |
NPI | 1043690290 |
---|---|
Provider Name | Muhammad Raza |
First Address | Jackson Heights, NY 11372-6134 |
Second Address | Jackson Heights, NY 11372-6134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2015 |
Last Update Date | 03/10/2020 |