Individual
LISA HOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
66 MONTAGUE ST, BROOKLYN, NY 11201-3342
(718) 596-4742
Mailing address
66 MONTAGUE ST, BROOKLYN, NY 11201-3342
(718) 596-4742
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
0095991
NY
Other
Enumeration date
10/29/2008
Last updated
10/29/2008
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