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1093769416
RICHARD DECLUE
WEST ISLIP, NY
NPI
1093769416
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NY 001473)
Enumeration Date
2006-05-20
Last Update Date
2008-05-29
Business Address
Mr. RICHARD DECLUE PA
1000 MONTAUK HWY
WEST ISLIP, NY 11795-4927
Phone number: 631-376-3000
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Mailing Address
Mr. RICHARD DECLUE PA
PO BOX 6010
HAUPPAUGE, NY 11788-9010
Phone number: 631-232-4000
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