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Organization

OPT2GO OUTLET INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. MICHELLE Q MIU (OWNER)
(917) 653-8836
Entity
Organization

Contact information

Practice address
219 CANAL ST FL 3, NEW YORK, NY 10013-4114
(646) 476-3021
Mailing address
219 CANAL ST FL 3, NEW YORK, NY 10013-4114

Taxonomy

Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
00-8841
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00000000
I AM APPLYING FOR MEDICAID, SO I DON'T KNOW THE ID NUMBER UNTIL I GET A NPI.
NY
05
00000000
NY
Enumeration date
06/18/2015
Last updated
06/18/2015
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