Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | NY8737 | NY |
NPI | 1073884912 |
---|---|
Provider Name | Mr. Allen M Golibersuch |
First Address | Alden, NY 14004-9529 |
Second Address | Alden, NY 14004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2012 |
Last Update Date | 24/01/2012 |