Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | D 806 | NJ |
NPI | 1023183589 |
---|---|
Provider Name | James Elmini |
First Address | Pompton Lakes, NJ 07442-1806 |
Second Address | Pompton Lakes, NJ 07442-1806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
222669276 | TAX NO. (01) | NJ |
D 806 | OPTICIANS LICENCE (01) | NJ |