Graduated: 1990
NPI: 1144298175
Practice Locations (3)
9001 A ROOSEVELT AVE, SUITE 2
JACKSON HEIGHTS, NY 113727938
7185050030
53 14 ROOSEVELT AVE, 3RD FLOOR
WOODSIDE, NY 113774239
5314 ROOSEVELT AVE, SUITE 3
WOODSIDE, NY 113774239
Source: CMS National Downloadable File, September 2026.