Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Dec 14, 2021
License(s)
030498 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 143 W 29TH ST FL 5 | New York, NY 10001-5150 | 201-308-6622 |
| MAILING | 6711 171ST ST | Fresh Meadows, NY 11365-3311 | 631-335-0050 |
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