Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 268055 | NY |
Y | 207PE0004X | Emergency Medical Services | 39027 | KY |
NPI | 1184689523 |
---|---|
Provider Name | Nail Bagautdinov |
First Address | New York, NY 10040-4039 |
Second Address | New York, NY 10040-4039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 12/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I30979 | (02) |