Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007235-1 | NY |
NPI | 1235161100 |
---|---|
Provider Name | Mrs. Jennifer Jeanne Proia-Cessna |
First Address | Brockport, NY 14420-1118 |
Second Address | Brockport, NY 14420-1118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 05/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1598707812 | OAK ORCHARD BROCKPORT NPI (01) | NY |
17209159 | EXCELLUS VENDOR # (01) | NY |
179014CT | PREFERRED CARE VENDOR # (01) | NY |