Individual
RICHARD S MENJIVAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
(631) 942-3593
Mailing address
154 SUFFOLK AVE, BRENTWOOD, NY 11717-4202
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
402787
NY
Other
Enumeration date
06/22/2020
Last updated
06/22/2020
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