Individual
MR. ANDRE MICHAEL VENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
155 W ROE BLVD, PATCHOGUE, NY 11772-2325
(914) 906-3735
Mailing address
145 DOGWOOD DR, WADING RIVER, NY 11792-1605
(914) 906-3735
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002919-1
NY
Other
Enumeration date
07/15/2019
Last updated
07/15/2019
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