Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 31TD00337700 | NJ |
NPI | 1124133145 |
---|---|
Provider Name | Mr. Valery Naymagon |
First Address | Brooklyn, NY 11229-2601 |
Second Address | Elizabeth, NJ 07202-3674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31TD00337700 | OPHTHALMIC DISPENSER # (01) | NJ |