Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C003776 | NY |
NPI | 1164638268 |
---|---|
Provider Name | Mr. Antonino Nicolosi |
First Address | Flushing, NY 11358-1928 |
Second Address | Flushing, NY 11358-1928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |