MRS. Desiree M Boucher

NPI #1194082198 in Holtsville, New York

Provider Information

NPI Number
1194082198
Entity Type
Individual
Name
MRS. Desiree M Boucher
Gender
Not Specified
Sole Proprietor
No
Primary Specialty
Specialist
Enumeration Date
Apr 13, 2012
Last Updated
Apr 13, 2012

Practice Location

Address
105 STORM DR
ZIP Code
11742-1912
Phone
(631) 831-6040

Specialties & Taxonomy Codes

Specialty
Specialist

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