Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 010220 | NY |
NPI | 1952946626 |
---|---|
Provider Name | Bryan Reshawn Trusell |
First Address | Brooklyn, NY 11222-5598 |
Second Address | Brooklyn, NY 11222-5598 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2019 |
Last Update Date | 26/12/2019 |