Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 004687-1 | NY |
NPI | 1134255854 |
---|---|
Provider Name | Mrs. Lisa Amy Madler |
First Address | Woodmere, NY 11598-1606 |
Second Address | Brooklyn, NY 11217-4036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004687-1 | OPTICIAN LICENSE (01) | NY |