Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C4340 | NY |
NPI | 1053449868 |
---|---|
Provider Name | Mr. John Tranchese |
First Address | Commack, NY 11725-1324 |
Second Address | Commack, NY 11725-1324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01459847 | (05) | NY |