Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C004553-1 | NY |
NPI | 1114954344 |
---|---|
Provider Name | Edward Todd Kent |
First Address | New York, NY 10011-7113 |
Second Address | New York, NY 10011-7113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00342970 | (05) | NY |