Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4664 | NY |
NPI | 1124357710 |
---|---|
Provider Name | Mr. Michael Allen Kwartner |
First Address | Woodbury, NY 11797-1204 |
Second Address | Woodbury, NY 11797-1204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2009 |
Last Update Date | 10/12/2009 |