Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 31TD00217000 | NJ |
NPI | 1003082298 |
---|---|
Provider Name | Mr. Christopher Drozd |
First Address | Cliffside Park, NJ 07010-3203 |
Second Address | Cliffside Park, NJ 07010-3203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2008 |
Last Update Date | 07/05/2008 |