Individual
STACEY MOMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2811 QUEENS PLZ N, LONG ISLAND CITY, NY 11101-4008
(718) 391-8300
Mailing address
18 LATOURETTE LN, STATEN ISLAND, NY 10314-6363
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
672582
NY
Other
Enumeration date
07/30/2014
Last updated
07/30/2014
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