Individual
MRS. ANTHONIA MODUPE WOSU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1555 LINCOLN BLVD, BAYSHORE, NY 11706
(631) 839-5713
Mailing address
1555 LINCOLN BLVD, BAYSHORE, NY 11706
(631) 839-5713
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
069662-01
NY
Other
Enumeration date
07/17/2012
Last updated
07/17/2012
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