Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jan 19, 2026
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 888 OLD COUNTRY RD | Plainview, NY 11803-4914 | 516-719-3000 |
| MAILING | 272 IRVING AVE | Deer Park, NY 11729-2217 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.