Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 008622-1 | NY |
NPI | 1114202223 |
---|---|
Provider Name | Ms. Nina J Pollic |
First Address | Greenwich, NY 12834-6109 |
Second Address | Greenwich, NY 12834-6109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2011 |
Last Update Date | 20/10/2011 |