Registry details
Type
Individual
Primary specialty
Physician Assistant, Medical
Enumerated
Sep 6, 2019
License(s)
023174 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 2849 37TH ST | Astoria, NY 11103-4332 | 718-278-0701 |
| MAILING | 2849 37TH ST | Astoria, NY 11103-4332 |
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