Individual
CAROL PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5711 225TH ST, 1 FL, OAKLAND GARDENS, NY 11364-2042
(917) 399-2221
Mailing address
5711 225TH ST, 1 FL, OAKLAND GARDENS, NY 11364-2042
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
494222111
NY
Other
Enumeration date
08/26/2014
Last updated
08/26/2014
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