Individual
BELKYS ALTAGRACIA PERDOMO ORTIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
14 LAWRENCE ST, NYACK, NY 10960-2923
(845) 358-1467
Mailing address
14 LAWRENCE ST, NYACK, NY 10960-2923
(845) 358-1467
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
015791
NY
Other
Enumeration date
06/01/2010
Last updated
06/01/2010
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