Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4036 | NY |
NPI | 1063549541 |
---|---|
Provider Name | Alan Fruchtman |
First Address | Staten Island, NY 10314-3515 |
Second Address | Staten Island, NY 10314-3515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |