Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 008483-1 | NY |
NPI | 1063447969 |
---|---|
Provider Name | Mrs. Leslie Ann Nishi |
First Address | Howard Beach, NY 11414-3742 |
Second Address | Howard Beach, NY 11414-3742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |