Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jan 26, 2011
License(s)
014169 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 259 1ST ST | Mineola, NY 11501-3957 | 516-663-3833 |
| MAILING | 1 GUSTAVE LEVY PLACE | New-York, NY 10029 |
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