Individual
LESLIE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 E FORDHAM RD, BRONX, NY 10458-5039
(718) 220-4176
(914) 517-8273
Mailing address
400 E FORDHAM RD, BRONX, NY 10458-5039
(718) 220-4176
(914) 517-8273
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
367232
NY
Other
Enumeration date
02/27/2019
Last updated
02/27/2019
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