Doctor Name: | MR. GERALD ANTHONY STIPO |
NPI Number: | 1063695609 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | OPTICIAN |
License Number: | COO3467-1 |
Business Practice Address: | 4 Cedar St Bronxville, NY - 107084102 |
Business Phone Number: | 9143371135 |
Business Fax Number: | 9143371135 |
Mailing Address: | 4 Cedar St, BRONXVILLE |
State: | NY |
Postal Code: | 107084102 |
Phone Number: | 9143371135 |
Fax Number: | 9143371135 |
NPI Enumeration Date: | 12/05/2007 |
NPI Last Update Date: | 12/12/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | COO3467-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |