Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 006356-1 | NY |
NPI | 1043494123 |
---|---|
Provider Name | Andrew M Cullen |
First Address | Rosedale, NY 11422-3113 |
Second Address | Rosedale, NY 11422-3113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/12/2007 |
Last Update Date | 25/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00724910 | (05) | NY |