Graduated: 2021
NPI: 1982145942
Practice Locations (2)
AHAVA MEDICAL AND REHABILITATION CENTER, LLC
25 CARRIER ST
LIBERTY, NY 127541903
84528172004053
STATLINE MEDICAL PC
120 HIGHLAND AVE
MIDDLETOWN, NY 109404713
9142154748
Source: CMS National Downloadable File, September 2026.