Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 004134 | NY |
NPI | 1093055469 |
---|---|
Provider Name | Mr. David Rogot |
First Address | New York, NY 10040-1001 |
Second Address | New York, NY 10040-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2013 |
Last Update Date | 22/02/2013 |