Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007961-1 | NY |
NPI | 1083808778 |
---|---|
Provider Name | Manuel Berrios |
First Address | Bronx, NY 10458-7805 |
Second Address | Bronx, NY 10458-7805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 05/09/2007 |