Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2024-06-25
- Last updated
- 2024-06-25
Specialties
Licenses
- License NY
- Number not in the file
Location
- Practice location
- 2155 STATE ROUTE 22B
- City
- MORRISONVILLE NY
- Postal code
- 129623417
- Phone
- 518-926-7100
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.