Individual
CANDICE GROGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
90 AIR PARK DR, RONKONKOMA, NY 11779-7360
(631) 580-4001
Mailing address
90 AIR PARK DR, RONKONKOMA, NY 11779-7360
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1400608
NY
Other
Enumeration date
08/13/2021
Last updated
08/13/2021
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