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1083960538
LOUIS PROVENZANO
BROOKLYN, NY
NPI
1083960538
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
174400000X Specialist
(Licence: NY 1289275)
Enumeration Date
2012-08-01
Last Update Date
2012-08-01
Business Address
-- LOUIS PROVENZANO
25 CHAPEL ST SUITE 704
BROOKLYN, NY 11201-1952
Phone number: 718-522-7300
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Mailing Address
-- LOUIS PROVENZANO
260 65TH ST #10P
BROOKLYN, NY 11220-4816
Phone number: 718-753-6037
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