Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 272560 | NY |
NPI | 1013208859 |
---|---|
Provider Name | Sam Serouya |
First Address | New York, NY 10016-6402 |
Second Address | New York, NY 10016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2011 |
Last Update Date | 02/04/2021 |