Individual
MR. ODED HAIDATOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
14707A 77TH RD, FLUSHING, NY 11367-3428
(646) 898-7420
Mailing address
14707A 77TH RD, FLUSHING, NY 11367-3428
(646) 898-7420
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
015869
NY
Other
Enumeration date
08/10/2012
Last updated
09/13/2012
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