Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Oct 21, 2020
License(s)
F346798 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 55 WATER ST FL 2 | New York, NY 10041-0010 | 646-680-2888 |
| LOCATION | 932 SOUTHERN BOULEVARD | Bronx, NY 10459-4506 | 646-680-5250 |
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.