Individual
MR. IGOR VALERY SUPITSKIY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPHTHALMIC DISPENSER
Contact information
Practice address
1018 NOSTRAND AVE # C, BROOKLYN, NY 11225-3509
(718) 773-9391
(718) 773-9391
Mailing address
4729 BEDFORD AVE, BROOKLYN, NY 11235-2607
(718) 773-9391
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
007691-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02241078
—
NY
Enumeration date
10/04/2006
Last updated
07/08/2007
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