Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 057291 | NY |
NPI | 1104203272 |
---|---|
Provider Name | Yaakov Allaeb |
First Address | Kew Gardens Hills, NY 11367-2811 |
Second Address | White Plains, NY 10601-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2015 |
Last Update Date | 08/05/2020 |