Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 4084-1 | NY |
NPI | 1205147501 |
---|---|
Provider Name | Mr. Glen F. Pomerantz |
First Address | Red Hook, NY 12571 |
Second Address | Lake Katrine, NY 12449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 01/07/2010 |