Individual
AMA OSEI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2811 QUEENS PLZ N, LONG ISLAND CITY, NY 11101-4172
(718) 391-8300
Mailing address
2490 3RD AVE APT 3H, BRONX, NY 10454-3733
(347) 394-9015
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
797687-01
NY
Other
Enumeration date
04/15/2026
Last updated
04/15/2026
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