Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 009384-1 | NY |
NPI | 1134540875 |
---|---|
Provider Name | Avrohom A Manes |
First Address | Monsey, NY 10952-3005 |
Second Address | Monsey, NY 10952-3005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2013 |
Last Update Date | 24/12/2013 |