Graduated: 2025
NPI: 1942187653
Practice Locations (4)
PO BOX, SUITE 25213
BELFAST, ME 049152003
80 5TH AVE, SUITE 903 10
NEW YORK, NY 100118020
820 US ROUTE 9 NORTHWAY PLAZA, SUITE 4F
QUEENSBURY, NY 128041766
6 MARGARETTA CT
Staten Island, NY 103142939
Source: CMS National Downloadable File, September 2026.