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1720475866
KOJO WALLACE
BAY SHORE, NY
NPI
1720475866
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2086S0127X Surgery, Trauma Surgery
(Licence: NY 312140)
Enumeration Date
2015-04-15
Last Update Date
2024-06-14
Business Address
KOJO WALLACE MD
301 E MAIN ST
BAY SHORE, NY 11706-8408
Phone number: 631-968-3000
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Mailing Address
KOJO WALLACE MD
909 STATION WAY
HUNTINGTON STATION, NY 11746-1971
Phone number:
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