Individual
JERRY T ROY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 MADISON ST, SYRACUSE, NY 13210-2319
(315) 426-3600
Mailing address
101 WESTHOLM BLVD, SYRACUSE, NY 13219-2914
(315) 418-0672
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
836464
NY
Other
Enumeration date
09/25/2024
Last updated
09/25/2024
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