Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 004897-2 | NY |
NPI | 1205091352 |
---|---|
Provider Name | Mr. Dennis P Brady |
First Address | Jefferson Valley, NY 10535-1512 |
Second Address | Jefferson Valley, NY 10535-1512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 28/07/2008 |