Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 007063-1 | NY |
N | 156FX1100X | Ophthalmic | 34TD00331300 | NJ |
NPI | 1215915731 |
---|---|
Provider Name | Mr. Igor Slony |
First Address | South Richmond Hill, NY 11419-1902 |
Second Address | South Richmond Hill, NY 11419-1902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 08/07/2007 |