Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25MA08821500 | NJ |
N | 208600000X | Surgeon | 25MA08821500 | NJ |
N | 2086S0120X | Pediatric Surgery | 253600 | NY |
Y | 2086S0120X | Pediatric Surgery | 25MA08821500 | NJ |
N | 2086S0120X | Pediatric Surgery | C169195 | CA |
N | 2086S0120X | Pediatric Surgery | ME136023 | FL |
NPI | 1144322561 |
---|---|
Provider Name | Sathyaprasad C Burjonrappa |
First Address | Philadelphia, PA 19182-9642 |
Second Address | New Brunswick, NJ 08901-1962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 23/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100539000 | (05) | FL |
NE0W8 | BLUE CROSS BLUE SHIELD (01) | FL |