Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 010173 | NY |
NPI | 1073288148 |
---|---|
Provider Name | Sandra Milena Martinez |
First Address | Brooklyn, NY 11208-1619 |
Second Address | Corona, NY 11368-3304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2021 |
Last Update Date | 11/08/2021 |