Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C009255 | NY |
NPI | 1013366202 |
---|---|
Provider Name | Gregory Freidus |
First Address | New York, NY 10024-1215 |
Second Address | New York, NY 10011-6601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2016 |
Last Update Date | 08/06/2016 |