Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 1-876 | WI |
Y | 207T00000X | Neurosurgeon | 310669 | NY |
NPI | 1093183543 |
---|---|
Provider Name | Raphael Sacho |
First Address | Staten Island, NY 10309-2802 |
Second Address | Staten Island, NY 10305-3400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2015 |
Last Update Date | 06/08/2021 |