Individual
MR. PINKHOZ YUSUPOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
11811 QUEENS BLVD, FOREST HILLS, NY 11375-7202
(718) 793-2461
(718) 793-2455
Mailing address
11811 QUEENS BLVD, FOREST HILLS, NY 11375-7202
(718) 793-2461
(718) 785-2926
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
007169-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02245238
—
NY
Enumeration date
11/09/2005
Last updated
04/27/2015
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