Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jun 4, 2017
License(s)
021605 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 154 W 127TH ST | New York, NY 10027-3739 | 212-749-3508 |
| MAILING | 1065 SOUTHERN BLVD | Bronx, NY 10459-2417 | 718-589-2440 |
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