Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 31TD00163200 | NJ |
NPI | 1083863948 |
---|---|
Provider Name | Ms. Angela Dragotto |
First Address | Wyckoff, NJ 07481-1058 |
Second Address | Midland Park, NJ 07432-1969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 20/05/2010 |