Individual
MR. KENNETH ROBERT NILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
109 CROCUS AVE, FLORAL PARK, NY 11001-2637
(516) 775-5138
Mailing address
109 CROCUS AVE, FLORAL PARK, NY 11001
(516) 775-5138
Taxonomy
Speciality
Code
Description
License number
State
1835G0303X
Geriatric Pharmacist
Primary
0433351
NY
Other
Enumeration date
03/26/2009
Last updated
03/26/2009
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