Individual
ETHAN BARDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
165 MAIN ST, STE A, CORTLAND, NY 13045-3049
(607) 753-0234
Mailing address
165 MAIN ST, STE A, CORTLAND, NY 13045-3049
(607) 753-0234
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
101837
NY
Other
Enumeration date
08/16/2019
Last updated
08/16/2019
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