Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 004059-1 | NY |
NPI | 1144556929 |
---|---|
Provider Name | Mr. Frank Cirillo JR. |
First Address | Albany, NY 12203-2405 |
Second Address | Albany, NY 12203-2405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2009 |
Last Update Date | 28/10/2009 |