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General NPI Number Information
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NPI Number | 1912389636
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Entity Type | Organization
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Legal Business Name | OPT2GO OUTLET INC
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 219 CANAL ST FL 3
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City | NEW YORK
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State | NY
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Zip | 10013-4114
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Country | US
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Telephone | 646-476-3021
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Fax |
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Provider Business Mailing Address
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Address Line | 219 CANAL ST FL 3
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City | NEW YORK
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State | NY
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Zip | 10013-4114
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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 | OWNER
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Name | MS. MICHELLE Q MIU
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Credential |
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Telephone | 917-653-8836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 00-8841
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License Number State | NY
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