Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic |
NPI | 1023375987 |
---|---|
Provider Name | Bronislav Mednik |
First Address | Brooklyn, NY 11209-3104 |
Second Address | Brooklyn, NY 11209-3104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2012 |
Last Update Date | 26/05/2017 |