Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 009133 | NY |
N | 152W00000X | Optometrist | 3110 | CT |
NPI | 1003461880 |
---|---|
Provider Name | Vivek Goyal |
First Address | Albertson, NY 11507-1157 |
Second Address | Jamaica, NY 11432-4904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2019 |
Last Update Date | 25/06/2020 |