Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2007-09-04
- Last updated
- 2007-09-04
Specialties
Licenses
- License NY
- 170940-1
Location
- Practice location
- 19 BRITTANY CT
- City
- RIDGE NY
- Postal code
- 119613124
- Phone
- 631-923-0217
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.