Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 200827 | NY |
Y | 208200000X | Surgeon | 200827 | NY |
Y | 208600000X | Surgeon | 200827 | NY |
NPI | 1669448445 |
---|---|
Provider Name | Sasan Roayaie |
First Address | New York, NY 10029-6574 |
Second Address | New York, NY 10029-6501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 20/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02090848 | (05) | NY |
E62412 | (02) |