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General NPI Number Information
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NPI Number | 1912176355
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Entity Type | Organization
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Legal Business Name | SAMUEL HERBST
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 5202 16TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11204-1408
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Country | US
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Telephone | 718-436-5900
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Fax | 718-854-0570
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Provider Business Mailing Address
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Address Line | 5202 16TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11204-1408
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Country | US
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Telephone | 718-436-5900
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Fax | 718-854-0570
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Authorized Official
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Title or Position | MANAGER
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Name | MR. BENZION HERBST
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Credential |
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Telephone | 718-436-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | C003535-1
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License Number State | NY
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