Individual
ANDRE MEZILUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4 POLK CT, APT P4, CORAM, NY 11727-3915
(646) 894-1055
Mailing address
4 POLK CT, APT P4, CORAM, NY 11727-3915
(646) 894-1055
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
302390
NY
Other
Enumeration date
07/19/2011
Last updated
07/19/2011
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