MEDICARE: DR. PONNI SUBBIAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	206270	NY

General Provider Information

NPI Number	:	1649684143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PONNI SUBBIAH

Provider Business Mailing Address
First Line	:	480 MISSION BAY BLVD N UNIT 1306
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94158-2176
Country	:	US
Telephone Number	:	917-217-9093
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 MISSION BAY BLVD N UNIT 1306
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94158-2176
Country	:	US
Telephone Number	:	917-217-9093
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	06/12/2014

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