Individual
IMMA FORESTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
230 W 17TH ST, NEW YORK, NY 10011-5325
(212) 206-5200
(212) 206-5279
Mailing address
230 W 17TH ST, NEW YORK, NY 10011-5325
(212) 206-5200
(212) 206-5279
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
297092
NY
Other
Enumeration date
06/02/2015
Last updated
01/11/2021
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