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Individual

DENISE M BOLAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RPA C

Contact information

Practice address
4 SANTANONI DR, NEWCOMB, NY 12852
(518) 582-2991
(518) 582-2040
Mailing address
4 SANTANONI DR, NEWCOMB, NY 12852-1913
(518) 582-2991
(518) 582-2393

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0027151
NY
363AM0700X
Medical Physician Assistant
Primary
002715
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01110874
NY
Enumeration date
11/08/2006
Last updated
10/04/2016
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