Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 139157 | NY |
NPI | 1104970516 |
---|---|
Provider Name | Susan Chirayil |
First Address | Westbury, NY 11590-1115 |
Second Address | Queens Village, NY 11427-2193 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |