Individual
AGNES M MCCONLOGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAPT
Contact information
Practice address
252 ISLIP AVE, ISLIP, NY 11751-3015
(631) 581-6800
(631) 581-6814
Mailing address
2 HUYLER CT, SETAUKET, NY 11733-1308
(631) 751-7968
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
013987
NY
Other
Enumeration date
02/02/2007
Last updated
07/08/2007
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