Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 004495 | NY |
NPI | 1134207426 |
---|---|
Provider Name | Kenneth Usatch |
First Address | White Plains, NY 10604-2901 |
Second Address | White Plains, NY 10604-2901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |