Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1100X | Ophthalmic | 008716-1 | NY |
Y | 156FX1800X | Optician | 008716-1 | NY |
NPI | 1265600969 |
---|---|
Provider Name | Lyubomyra Kolesnyk |
First Address | Brooklyn, NY 11229-0740 |
Second Address | Brooklyn, NY 11217-2023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2008 |
Last Update Date | 03/06/2008 |