Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5974897 | NY |
NPI | 1073749636 |
---|---|
Provider Name | Milana Dostova |
First Address | Brooklyn, NY 11217 |
Second Address | Brooklyn, NY 11217-3278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 09/06/2009 |