Individual
JAISON JACOB DANIEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19213 UNION TPKE, FRESH MEADOWS, NY 11366-1865
(718) 468-9800
Mailing address
225 PRINCESS ST, HICKSVILLE, NY 11801-1148
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T009076
NY
Other
Enumeration date
11/08/2019
Last updated
12/16/2019
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