Individual
LUIS ANGEL RIQUELME III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-3208
(631) 358-1201
(631) 444-8850
Mailing address
16 WESTMINSTER LN, WEST ISLIP, NY 11795-2620
(631) 747-2526
(631) 444-8850
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
016630
NY
Other
Enumeration date
06/26/2013
Last updated
05/09/2024
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