Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007175 | NY |
NPI | 1205077526 |
---|---|
Provider Name | Jackie H Wu |
First Address | Brooklyn, NY 11214-4509 |
Second Address | Brooklyn, NY 11214-4509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2009 |
Last Update Date | 01/02/2012 |