Individual
MR. ANTHONY GARRICK LIDDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.N.
Contact information
Practice address
31 CENTER DR, RIVERHEAD, NY 11901-1079
(631) 369-3179
Mailing address
31 CENTER DR, RIVERHEAD, NY 11901-1079
(631) 369-3179
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
311434
NY
Other
Enumeration date
03/19/2013
Last updated
03/19/2013
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