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General NPI Number Information
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NPI Number | 1871228833
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Entity Type | Individual
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Provider Name | SHARON ITZHAKOV
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Gender | Female
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 9519 63RD DR
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City | REGO PARK
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State | NY
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Zip | 11374-2024
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Country | US
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Telephone | 718-459-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 7155 169TH ST
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-3348
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 009620
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License Number State | NY
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