Individual
BRYAN SPONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2000 EMPIRE BLVD STE 120, WEBSTER, NY 14580-1957
(585) 922-0930
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
311862
NY
Other
Enumeration date
07/16/2024
Last updated
07/16/2024
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