Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007838-1 | NY |
NPI | 1053567628 |
---|---|
Provider Name | Renata Nannetti |
First Address | Staten Island, NY 10309-4602 |
Second Address | Staten Island, NY 10306-4352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2008 |
Last Update Date | 14/12/2009 |