Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 27OA00583400 | NJ |
NPI | 1316978851 |
---|---|
Provider Name | Nermin Gendy |
First Address | Red Bank, NJ 07701-5928 |
Second Address | Red Bank, NJ 07701-5928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V03509 | (02) | NJ |