Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C003899 | NY |
NPI | 1235485749 |
---|---|
Provider Name | Mr. Michael F. Malachowski |
First Address | West Seneca, NY 14224-4624 |
Second Address | West Seneca, NY 14224-4624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2012 |
Last Update Date | 02/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0578410002 | (02) | NY |