Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 253663 | NY |
NPI | 1992933519 |
---|---|
Provider Name | Dr. Azza Elemam |
First Address | Staten Island, NY 10310-2507 |
Second Address | Staten Island, NY 10310-2507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 31/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200972670 | (05) | IN |
7100082840 | (05) | KY |