Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TUV007693-1 | NY |
NPI | 1003102161 |
---|---|
Provider Name | Marta Fabrykowski |
First Address | New York, NY 10065-7471 |
Second Address | New York, NY 10065-7471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2011 |
Last Update Date | 10/07/2012 |