Individual
MRS. LIZ S DEJESUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
706 EXECUTIVE BLVD STE D, VALLEY COTTAGE, NY 10989-2039
(845) 362-3904
Mailing address
12 HIGH RIDGE RD, STONY POINT, NY 10980-2710
(646) 271-0750
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
703033
NY
Other
Enumeration date
10/16/2017
Last updated
10/16/2017
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