Individual
MINDY FORTGANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSED
Contact information
Practice address
14 COTTAGE CT., HUNTINGTON STATION, NY 11746
(631) 807-3026
Mailing address
14 COTTAGE CT, HUNTINGTON STATION, NY 11746-1105
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
07/18/2012
Last updated
07/18/2012
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