Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007320 | NY |
NPI | 1013985431 |
---|---|
Provider Name | Marat Shlimov |
First Address | Brooklyn, NY 11212-2434 |
Second Address | Brooklyn, NY 11212-2434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 08/07/2007 |