Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Dec 19, 2019
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1400 PELHAM PKWY S | Bronx, NY 10461-1138 | 201-221-9693 |
| MAILING | 3800 STEVENS RD APT 3823 | Wallington, NJ 07057-2780 |
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