Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TUV0068431 | NY |
NPI | 1003910258 |
---|---|
Provider Name | Ms. Susan E Hong |
First Address | New York City, NY 10016-3422 |
Second Address | Rockaway Park, NY 11694-2209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2006 |
Last Update Date | 10/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V03815 | (02) |