| | Physician Last Name: | Rochdale Medica |
| | Physician First Name: | P.C. |
| | Physician Middle Name: | |
| | Address: | 137-04 Guy R. Brewer Boulevard
Jamaica, New York 11434 |
| | License Number: | 193948 |
| | License Type: | |
| | Year of Birth: |
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| | Effective Date: | 11/23/2005 |
| | Action Description for DOH Webpage: | Revocation of Certificate of Incorporation.The Hearing Committee's November 23, 2005 revocation was later affirmed on February 28, 2006 by the Review Board. |
| | Misconduct Description for DOH Webpage: | Not applicable |
| | License Limitations or Conditions for DOH Webpage: | |
| | Board Order: |
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