Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 009178 | NY |
Y | 152W00000X | Optometrist | NA | NY |
NPI | 1003425018 |
---|---|
Provider Name | Reshmi Kurup |
First Address | Montrose, NY 10548-1454 |
Second Address | Montrose, NY 10548-1454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2020 |
Last Update Date | 26/07/2020 |