Individual
AMANDA J PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
291 CHANNON RD, HEWLETT, NY 11557-2701
(516) 287-7092
Mailing address
291 CHANNON RD, HEWLETT, NY 11557-2701
(516) 287-7092
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
828359
NY
Other
Enumeration date
12/03/2018
Last updated
12/03/2018
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