Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | 3832866 | NE |
NPI | 1437731551 |
---|---|
Provider Name | Mrs. Rachel Bodek |
First Address | Suffern, NY 10901-4301 |
Second Address | Brooklyn, NY 11206-5091 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2021 |
Last Update Date | 27/04/2021 |