Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 266213 | NY |
NPI | 1053540351 |
---|---|
Provider Name | Mustafain Y Meghani |
First Address | Troy, NY 12180-3482 |
Second Address | Troy, NY 12180-3482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2009 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03622906 | (05) | NY |
266213 | NYS LICENSE (01) | NY |