Individual
MR. JERRY L CORP II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
255 DELAWARE AVE, BUFFALO, NY 14202-2016
(716) 884-0888
Mailing address
255 DELAWARE AVE, BUFFALO, NY 14202-2016
(716) 884-0888
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402647
NY
Other
Enumeration date
04/25/2016
Last updated
02/07/2020
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