Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 010023-1 | NY |
NPI | 1053827618 |
---|---|
Provider Name | Jennifer Marie Carney |
First Address | Fulton, NY 13069-1572 |
Second Address | Fulton, NY 13069-1572 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2017 |
Last Update Date | 19/12/2017 |