Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 003543 | NY |
NPI | 1033254453 |
---|---|
Provider Name | Mr. Gilbert Purisch |
First Address | Brooklyn, NY 11231 |
Second Address | Brooklyn, NY 11231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |