Registry details
Type
Individual
Primary specialty
Physician Assistant, Medical
Enumerated
Nov 18, 2021
License(s)
027405 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1010 S ONEIDA ST APT B306 | Denver, CO 80224-3592 | 720-676-8333 |
| LOCATION | 711 TROY SCHENECTADY RD STE 206 | Latham, NY 12110-2461 | 518-674-9060 |
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.