Individual
KELLY BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 IRELAND PL, AMITYVILLE, NY 11701-2955
(631) 514-9750
Mailing address
351 44TH ST, LINDENHURST, NY 11757-2310
(631) 514-9750
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Enumeration date
04/13/2020
Last updated
04/13/2020
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