Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 296191-1 | NY |
NPI | 1568728806 |
---|---|
Provider Name | Peyman Bizargity |
First Address | Lake Success, NY 11020 |
Second Address | Lake Success, NY 11020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2012 |
Last Update Date | 31/12/2018 |