Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 009849-1 | |
N | 156FX1800X | Optician | 009849-1 | NY |
NPI | 1003322363 |
---|---|
Provider Name | Joan Marie Lorio |
First Address | East Setauket, NY 11733-3334 |
Second Address | East Setauket, NY 11733-3334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2017 |
Last Update Date | 22/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009849-1 | (05) | NY |