Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5062 | NY |
NPI | 1114061330 |
---|---|
Provider Name | Joseph Lerner |
First Address | Plainview, NY 11803-4045 |
Second Address | Plainview, NY 11803-4045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 18/12/2007 |