Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 253737 | NY |
NPI | 1003070558 |
---|---|
Provider Name | Peter Urazov |
First Address | East Patchogue, NY 11772-8809 |
Second Address | East Patchogue, NY 11772-8809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 28/10/2013 |