Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007584-1 | NY |
NPI | 1013274687 |
---|---|
Provider Name | Lidia Mullaev |
First Address | New York, NY 10065-8110 |
Second Address | New York, NY 10065-8110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 19/04/2012 |