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General NPI Number Information
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NPI Number | 1649333493
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Entity Type | Organization
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Legal Business Name | NORTHEAST SPEC CORP
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16 OLD GICK RD
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City | WILTON
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State | NY
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Zip | 12866
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Country | US
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Telephone | 518-587-0258
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Fax | 518-583-3991
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Provider Business Mailing Address
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Address Line | PO BOX 496
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City | DELMAR
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State | NY
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Zip | 12054
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Country | US
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Telephone | 518-587-0258
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Fax | 518-583-3991
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Authorized Official
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Title or Position | PRESIDENT OD
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Name | DR. KERRY LEE HARBECK
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Credential | OD
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Telephone | 518-587-0258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T003818
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License Number State | NY
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