Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | 009414-1 | NY |
NPI | 1841535218 |
---|---|
Provider Name | Boris Takhalov |
First Address | Hempstead, NY 11550-2155 |
Second Address | West Hempstead, NY 11552-2155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2012 |
Last Update Date | 07/05/2019 |