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Individual

DEFOREST CORNISH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
13122 223RD ST, LAURELTON, NY 11413-1646
(347) 715-0477
Mailing address
13122 223RD ST, LAURELTON, NY 11413-1646

Taxonomy

Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary

Other

Enumeration date
07/01/2019
Last updated
07/01/2019
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