Individual
ANTONETTE TIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
89 EDGEWORTH ST, VALLEY STREAM, NY 11581-3235
(516) 815-5321
Mailing address
89 EDGEWORTH ST, VALLEY STREAM, NY 11581-3235
(516) 815-5321
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
767586
NY
Other
Enumeration date
07/17/2019
Last updated
07/17/2019
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