Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 000743 | CT |
NPI | 1184815136 |
---|---|
Provider Name | Nathaniel Senderoff |
First Address | Meriden, CT 06450-7164 |
Second Address | Meriden, CT 06450-7164 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 06/08/2007 |