Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 0003343 | NY |
NPI | 1073703930 |
---|---|
Provider Name | Nicholas Guerra |
First Address | New York, NY 10028-0413 |
Second Address | New York, NY 10028-0413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2007 |
Last Update Date | 26/07/2007 |