Individual
ANDRE WILLIAM DE JESUS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
800 IRVING AVE, SYRACUSE, NY 13210-2716
(315) 425-4400
Mailing address
102 LIONEL AVE, SOLVAY, NY 13209-2410
(315) 575-7047
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
013346-01
NY
Other
Enumeration date
09/02/2022
Last updated
09/02/2022
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