Healthcare Provider Details

I. General information

NPI: 1548461031
Provider Name (Legal Business Name): MINOUSHA ZAMRA BARI OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SHERRILL RD
SHERRILL NY
13461-1461
US

IV. Provider business mailing address

27 CLARION DR
WHITESBORO NY
13492-2703
US

V. Phone/Fax

Practice location:
  • Phone: 315-363-8288
  • Fax: 315-363-8814
Mailing address:
  • Phone: 917-502-0161
  • Fax: 315-363-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number011390-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: