Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 584 | NH |
NPI | 1235123696 |
---|---|
Provider Name | Joseph A Serratore |
First Address | Concord, NH 03301-3502 |
Second Address | Concord, NH 03301-3502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 08/07/2007 |