Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 009771 | NY |
NPI | 1467064709 |
---|---|
Provider Name | Victoria Rose Nieto |
First Address | Staten Island, NY 10309-1159 |
Second Address | Keansburg, NJ 07734-1768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2020 |
Last Update Date | 18/08/2020 |