Individual
MR. ALGERNON ANTHONY STEPHEN WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
68 S SERVICE RD STE 100, MELVILLE, NY 11747-2350
(631) 629-2493
(631) 629-6945
Mailing address
4 DENMARK CT, HUNTINGTON, NY 11743-4734
(631) 334-9572
(631) 629-6945
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
03/20/2018
Last updated
03/21/2018
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