Individual
IDA ANJOMSHOAA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3353 82ND ST, A01, JACKSON HEIGHTS, NY 11372-1447
(718) 899-7811
Mailing address
306 MOTT ST, APT #4C, NEW YORK, NY 10012
(718) 899-7811
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
058065
NY
Other
Enumeration date
01/04/2013
Last updated
03/17/2016
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