Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jan 19, 2021
License(s)
026193 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 721 HANSHAW RD | Ithaca, NY 14850-1542 | 607-342-3512 |
| LOCATION | 1020 CRAFT RD STE C | Ithaca, NY 14850-1016 | 607-339-0625 |
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.