Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Mar 22, 2025
License(s)
773006 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 122 RUSSEK DR | Staten Island, NY 10312-1641 | 347-308-3475 |
| LOCATION | 122 RUSSEK DR | Staten Island, NY 10312-1641 | 347-308-3475 |
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