Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 96-270-08 | NH |
NPI | 1154429736 |
---|---|
Provider Name | Mr. Peter J Kazanovicz |
First Address | Bedford, NH 03110-6971 |
Second Address | Bedford, NH 03110-6971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7501595 | (05) | MA |