Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007261-1 | NY |
NPI | 1003032418 |
---|---|
Provider Name | Mr. Dmitry Vayner |
First Address | Brooklyn, NY 11223-3741 |
Second Address | Brooklyn, NY 11223-3741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01898264 | (05) | NY |