Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2014-12-18
- Last updated
- 2014-12-18
Specialties
Licenses
- License NY
- 72057377
Location
- Practice location
- 770 EMBOUGHT RD
- City
- CATSKILL NY
- Postal code
- 124145312
- Phone
- 518-943-0574
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.