Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4779 | NY |
NPI | 1124143367 |
---|---|
Provider Name | Mr. Larry B Greenspan |
First Address | Cedarhurst, NY 11516-2130 |
Second Address | Cedarhurst, NY 11516-2130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 12/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OP1364 | PROVIDER ID# FOR EYEMED (01) | NY |