Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 222211 | NY |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 222211 | NY |
NPI | 1134143324 |
---|---|
Provider Name | Supriyo Das |
First Address | Wappingers Falls, NY 12590-7128 |
Second Address | Wappingers Falls, NY 12590-7128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 22/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H53000 | (02) |