Graduated: 1978
NPI: 1407838766
Practice Locations (3)
1000 E STUART ST
FORT COLLINS, CO 805251555
2127346621
284 PARK AVE
PASSAIC, NJ 070554455
2127346621
2 A SHORE PARK RD
GREAT NECK, NY 110232029
7187604221
Source: CMS National Downloadable File, September 2026.