Individual
IRA CAMHI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
621 KATAN AVE, STATEN ISLAND, NY 10312
(718) 948-4000
(718) 948-4001
Mailing address
621 KATAN AVE, STATEN ISLAND, NY 10312
(718) 948-4000
(718) 948-4001
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
028638
NY
Other
Enumeration date
11/30/2005
Last updated
07/08/2007
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