Individual
MR. ROBERT MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
7517 37TH AVE, JACKSON HEIGHTS, NY 11372-6537
(718) 779-1222
Mailing address
7517 37TH AVE, JACKSON HEIGHTS, NY 11372-6537
(718) 779-1222
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00751157
—
NY
Enumeration date
10/24/2005
Last updated
07/12/2007
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