Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 233158 | NY |
NPI | 1023182649 |
---|---|
Provider Name | Radhakrishman Satheesan |
First Address | Brooklyn, NY 11219-2923 |
Second Address | Brooklyn, NY 11219-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02598507 | (05) | NY |
I20644 | (02) | NY |