Individual
MR. POLYCARP I EZEOLU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
9832 57TH AVE, SUITE 12-G, CORONA, NY 11368-4914
(718) 271-0526
Mailing address
9832 57TH AVE, SUITE 12-G, CORONA, NY 11368-4914
(718) 271-0526
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
003536
NY
Other
Enumeration date
04/25/2007
Last updated
07/08/2007
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