Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1800X | Optician | 00003468 | NY |
Y | 156FX1800X | Optician | 31TD00083700 | NJ |
NPI | 1083771109 |
---|---|
Provider Name | Mr. Christopher Velazquez |
First Address | Cedar Grove, NJ 07009-2127 |
Second Address | Jersey City, NJ 07304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |