Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 4301118999 | MI |
Y | 207W00000X | Ophthalmologist | 64822 | CT |
NPI | 1033598404 |
---|---|
Provider Name | Ari M. Brandsdorfer |
First Address | Farmington, CT 06032-1933 |
Second Address | Farmington, CT 06032-1933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2015 |
Last Update Date | 23/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033598404 | (05) | CT |