Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Mar 13, 2026
License(s)
357149 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 187 HIGHWAY 36 STE 230 | West Long Branch, NJ 07764-1306 | 732-702-1039 |
| LOCATION | 20 HAGEN DR STE 330 | Rochester, NY 14625-2664 | 585-267-4040 |
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