Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 31TD00326600 | NJ |
NPI | 1205013885 |
---|---|
Provider Name | Basel R Altahtamoni |
First Address | Jersey City, NJ 07307-4123 |
Second Address | Jersey City, NJ 07307-4123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2008 |
Last Update Date | 26/01/2008 |