Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 282778 | NY |
NPI | 1003079286 |
---|---|
Provider Name | Syra Hanif |
First Address | New York, NY 10011-3639 |
Second Address | New York, NY 10011-3639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 12/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05569264 | (05) | NY |