Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2011-01-10
- Last updated
- 2011-01-18
Specialties
Licenses
- License NY
- 4518718
Location
- Practice location
- 47 BRAUNCROFT LN
- City
- SNYDER NY
- Postal code
- 142264946
- Phone
- 716-839-5981
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.