Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 9925 | NY |
NPI | 1114691201 |
---|---|
Provider Name | Chadlany Samson |
First Address | Woonsocket, RI 02895 |
Second Address | North Baldwin, NY 11510-2453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2021 |
Last Update Date | 03/08/2021 |