Individual
CHRIS DOHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
102 NEELYTOWN RD, CAMPBELL HALL, NY 10916-2807
(845) 422-6932
Mailing address
102 NEELYTOWN RD, CAMPBELL HALL, NY 10916-2807
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
276788
NY
Other
Enumeration date
10/22/2014
Last updated
10/22/2014
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