Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C005296-1 | NY |
NPI | 1174039937 |
---|---|
Provider Name | Victor Arthur Baldassari |
First Address | Cobleskill, NY 12043-5715 |
Second Address | Cobleskill, NY 12043-5715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2017 |
Last Update Date | 15/12/2017 |