Individual
MARY DEJONGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
848 PEIRSON AVE, NEWARK, NY 14513-9762
(315) 331-2086
Mailing address
848 PEIRSON AVE, NEWARK, NY 14513-9762
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
706183
NY
Other
Enumeration date
10/29/2015
Last updated
10/29/2015
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