Individual
BRIDGET QUINN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TEACHER
Contact information
Practice address
1400 OLD COUNTRY RD STE C-103N, WESTBURY, NY 11590-5156
(516) 806-6969
Mailing address
205 STEVEN PL APT 3C, WOODMERE, NY 11598-2504
(631) 804-8184
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
1208156
NY
Other
Enumeration date
07/02/2020
Last updated
07/02/2020
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