Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007390 | NY |
NPI | 1033553888 |
---|---|
Provider Name | Aurora Susi |
First Address | Bronx, NY 10461-3545 |
Second Address | Bronx, NY 10461-3545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 23/04/2013 |