Individual
CONSUELO A. SENIOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
460 W 34TH ST, 11TH FLOOR, NEW YORK, NY 10001-2320
(212) 273-6100
Mailing address
310 LENOX RD, APT. 4V, BROOKLYN, NY 11226-2274
(917) 459-9521
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
075320
LICENSE NUMBER
NY
Enumeration date
07/23/2007
Last updated
07/23/2007
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