Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Mar 26, 2019
License(s)
25IA12515800 (NJ)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 10 JAY ST # 6C | Brooklyn, NY 11201-1136 | 917-382-0901 |
| MAILING | 100 E 77TH ST | New York, NY 10075-1850 | 212-434-6262 |
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