Individual
MRS. ANTONELLA MODRUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
144 COVERT AVE, ELMONT, NY 11003-1138
(516) 326-5560
Mailing address
26 HASTINGS DR, FORT SALONGA, NY 11768-2509
(631) 239-1767
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
58 015880
NY
Other
Enumeration date
09/08/2010
Last updated
09/08/2010
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