Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 7028 | NY |
NPI | 1235524331 |
---|---|
Provider Name | Sergio Plisetsky |
First Address | Staten Island, NY 10306 |
Second Address | Staten Island, NY 10306-3048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2015 |
Last Update Date | 06/04/2015 |