Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 009269 | NY |
NPI | 1003460601 |
---|---|
Provider Name | Yonathan Tegenu |
First Address | Austin, TX 78753-2658 |
Second Address | New York, NY 10019-2121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2019 |
Last Update Date | 31/07/2019 |