Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 0997-01 | NY |
NPI | 1023615564 |
---|---|
Provider Name | Julietta Mullokandova |
First Address | Forest Hills, NY 11375-1119 |
Second Address | Bronx, NY 10458-6003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2020 |
Last Update Date | 07/10/2020 |