Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1205411709 |
---|---|
Provider Name | Zecharya Goldenberg |
First Address | Pikesville, MD 21208-5313 |
Second Address | Pikesville, MD 21208-5313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2021 |
Last Update Date | 16/03/2021 |