Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 008253 | NY |
NPI | 1134208200 |
---|---|
Provider Name | Ms. Yelena Gershman |
First Address | Staten Island, NY 10312-1336 |
Second Address | Staten Island, NY 10305-2015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |