Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1194239897 |
---|---|
Provider Name | Mr. Michael Shklyar |
First Address | Brooklyn, NY 11213-5579 |
Second Address | Brooklyn, NY 11213-5579 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2017 |
Last Update Date | 17/11/2017 |