Registry details
Type
Individual
Primary specialty
Anesthesiology, Pain Medicine
Enumerated
Apr 26, 2019
License(s)
320904 (NY), 320904 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 622 W 165TH ST | New York, NY 10032-7926 | 212-305-6144 |
| MAILING | 630 W 168TH ST # 4 | New York, NY 10032-3725 |
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