Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Sep 27, 2022
License(s)
349199 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 46 ELM ST | Staten Island, NY 10310-1526 | 646-725-8502 |
| LOCATION | 46 ELM ST | Staten Island, NY 10310-1526 | 646-725-8502 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.