Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant |
NPI | 1356740039 |
---|---|
Provider Name | Ms. Margaret Derago |
First Address | Lake Grove, NY 11755-1214 |
Second Address | Lake Grove, NY 11755-1214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2014 |
Last Update Date | 19/08/2014 |