Graduated: 2001
Offers telehealth
NPI: 1710008693
Practice Locations (2)
STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
100 SULLIVAN WAY
TRENTON, NJ 086250500
6096331562
308 SEAVIEW AVE
STATEN ISLAND, NY 103052246
718351171721
Source: CMS National Downloadable File, September 2026.