Healthcare Provider Details

I. General information

NPI: 1346512845
Provider Name (Legal Business Name): SANA USMANI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 06/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 BOYLE RD SUITE #7
SELDEN NY
11784-1955
US

IV. Provider business mailing address

239 BOYLE RD SUITE #7
SELDEN NY
11784-1955
US

V. Phone/Fax

Practice location:
  • Phone: 631-698-0600
  • Fax: 631-698-2212
Mailing address:
  • Phone: 631-698-0600
  • Fax: 631-698-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number265392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: