Organization
THE M.O.G.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSS CERTO P.T. (OWNER)
(716) 773-1600
Entity
Organization
Contact information
Practice address
1801 GRAND ISLAND BLVD, GRAND ISLAND, NY 14072-2171
(716) 773-1600
(716) 773-9418
Mailing address
1801 GRAND ISLAND BLVD, GRAND ISLAND, NY 14072-2171
(716) 773-1600
(716) 773-9418
Taxonomy
Speciality
Code
Description
License number
State
175L00000X
Homeopath
Primary
—
—
Other
Enumeration date
09/21/2009
Last updated
09/21/2009
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