Individual
DANIE E MENTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
373 BROADWAY, AMITYVILLE, NY 11701-2707
(631) 608-8523
Mailing address
373 BROADWAY, AMITYVILLE, NY 11701-2707
(631) 608-8523
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
314674
NY
Other
Enumeration date
07/12/2013
Last updated
07/12/2013
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