Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | T 004430 | NY |
NPI | 1003992603 |
---|---|
Provider Name | Dr. Leslie R. Kolker |
First Address | New Hyde Park, NY 11042-1011 |
Second Address | New Hyde Park, NY 11042-1011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 03/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T49071 | (02) | NY |