Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Jun 1, 2026
License(s)
F357709-01 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 486 WESTBURY AVE | Carle Place, NY 11514-1453 | 484-374-9067 |
| LOCATION | 165 N VILLAGE AVE STE 133 | Rockville Centre, NY 11570-3701 | 212-803-3339 |
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