Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 264552 | NY |
Y | 2084N0600X | Clinical Neurophysiologist | 264552 | NY |
NPI | 1497907273 |
---|---|
Provider Name | Shahram Izadyar |
First Address | Syracuse, NY 13202-2240 |
Second Address | Syracuse, NY 13202-2240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2008 |
Last Update Date | 21/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03462140 | (05) | NY |