Individual
AMY RUTH PENCOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
122 W 14TH ST, ELMIRA HEIGHTS, NY 14903-1249
(607) 734-5474
Mailing address
122 W 14TH ST, ELMIRA HEIGHTS, NY 14903-1249
(607) 734-5474
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
21HA1041516
NY
Other
Enumeration date
12/08/2022
Last updated
12/08/2022
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