Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007100 | NY |
NPI | 1093382004 |
---|---|
Provider Name | Ferderico Bernal |
First Address | Astoria, NY 11106-1276 |
Second Address | Astoria, NY 11106-1276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2021 |
Last Update Date | 08/06/2021 |