Provider Demographics
NPI:1982654901
Name:SANNI, NOAMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NOAMAN
Middle Name:
Last Name:SANNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 STATE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9406
Mailing Address - Country:US
Mailing Address - Phone:315-788-6070
Mailing Address - Fax:315-788-1950
Practice Address - Street 1:1815 STATE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9406
Practice Address - Country:US
Practice Address - Phone:315-788-6070
Practice Address - Fax:315-788-1950
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199713207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01704076Medicaid
NY01704076Medicaid
NYF90342Medicare UPIN