Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 056390 | NY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 056390 | NY |
NPI | 1093987158 |
---|---|
Provider Name | Nirmala Tasgaonkar |
First Address | Rochester, NY 14620-2989 |
Second Address | Buffalo, NY 14263-2989 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2008 |
Last Update Date | 11/02/2021 |