Registry details
Type
Individual
Primary specialty
Physician Assistant, Surgical
Enumerated
May 12, 2020
License(s)
025243 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1 CAMPUS RD | Staten Island, NY 10301-4495 | 718-619-1995 |
| MAILING | 512 VALLEYVIEW PL | Staten Island, NY 10314-5535 | 718-619-1995 |
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