Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1093839557 |
---|---|
Provider Name | Mr. Gregory Grizont |
First Address | North Brunswick, NJ 08902 |
Second Address | North Brunswick, NJ 08902-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |