Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 058084-1 | NY |
NPI | 1104200534 |
---|---|
Provider Name | Prashant Sukhani |
First Address | Brooklyn, NY 11215 |
Second Address | Brooklyn, NY 11215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2015 |
Last Update Date | 24/06/2019 |