Individual
AMANDA BETZOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1014 GRAND BLVD STE 5, DEER PARK, NY 11729-5782
(631) 243-1765
Mailing address
78 W 12TH ST, DEER PARK, NY 11729-4015
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/10/2023
Last updated
05/10/2023
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