Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jun 12, 2025
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 24121 87TH AVE | Bellerose, NY 11426-1207 | 516-849-3738 |
| LOCATION | 5645 MAIN ST | Flushing, NY 11355-5045 | 718-670-2000 |
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