Individual
MRS. CAROLINA SQUARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2724 VICTORY BLVD, APT. 2B, STATEN ISLAND, NY 10314-6643
(347) 820-2320
Mailing address
2724 VICTORY BLVD, APT. 2B, STATEN ISLAND, NY 10314-6643
(347) 820-2320
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
761489131
NY
174400000X
Specialist
Primary
761490131
NY
Other
Enumeration date
08/09/2013
Last updated
08/09/2013
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