Individual
DIANA POPPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
119 FULTON ST, LAWRENCE, NY 11559-1426
(347) 401-3681
Mailing address
119 FULTON ST, LAWRENCE, NY 11559-1426
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
017544-1
NY
Other
Enumeration date
10/13/2014
Last updated
10/13/2014
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