Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | BR3724514 | PA |
N | 207RR0500X | Rheumatology | J4668 | TX |
NPI | 1083604888 |
---|---|
Provider Name | Sady Theodoro Ribeiro |
First Address | Astoria, NY 11103-4182 |
Second Address | Long Island City, NY 11106-2561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 29/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1017731920001 | (05) | PA |
F 69423 | (02) | TX |