Facts
- Status
- A
- Credential
- D.P.M.
- Type
- Individual
- Enumeration date
- 2006-08-27
- Last updated
- 2016-04-21
Specialties
Licenses
- License NY
- N004965
Location
- Practice location
- 186 VILLAGE SQ
- City
- PAINTED POST NY
- Postal code
- 148701320
- Phone
- 607-936-9985
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.