Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2017-07-14
- Last updated
- 2018-03-17
Specialties
Licenses
- License NJ
- 28RI03742400
- License NY
- 061026
Location
- Practice location
- 3632 UNION ST STE A
- City
- FLUSHING NY
- Postal code
- 113544195
- Phone
- 718-961-6010
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.