Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Jan 28, 2010
License(s)
297914-1 (NY), 309889 (NY), 661674 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 170 ROUTE 25A | Rocky Point, NY 11778-9091 | 631-331-4377 |
| LOCATION | 170 ROUTE 25A | Rocky Point, NY 11778-9091 | 631-331-4377 |
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