Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 293490 | NY |
N | 208D00000X | General Practice Physician | 35.132418 | OH |
NPI | 1013270230 |
---|---|
Provider Name | Sohrab Virk |
First Address | Great Neck, NY 11021-5207 |
Second Address | Great Neck, NY 11021-5207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 16/07/2020 |