Registry details
Type
Individual
Primary specialty
Physician Assistant, Medical
Enumerated
Jul 23, 2018
License(s)
022335 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 150 55TH ST | Brooklyn, NY 11220-2508 | 718-630-6497 |
| MAILING | 109-42-111TH STREET | South Ozone Park, NY 11420 | 917-435-5003 |
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