Graduated: 1996
NPI: 1154632214
Practice Locations (3)
3343 CRESCENT ST, APT 4G
ASTORIA, NY 111063801
3343 CRESCENT ST, APT 4G
ASTORIA, NY 111063808
2125349764
229 E 85TH ST UNIT, SUITE 26
New York, NY 100289601
Source: CMS National Downloadable File, September 2026.