Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 7194 | NY |
NPI | 1164743019 |
---|---|
Provider Name | Jeffrey Paul Buenau |
First Address | Delmar, NY 12054-1244 |
Second Address | Delmar, NY 12054-1244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2010 |
Last Update Date | 15/06/2010 |