Individual
ANGELIQUE L GRISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
31 WASHINGTON ST, MIDDLETOWN, NY 10940-5234
(347) 420-1472
Mailing address
31 WASHINGTON ST, MIDDLETOWN, NY 10940-5234
(347) 420-1472
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
06/14/2012
Last updated
06/14/2012
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