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1043875974
TREVOR JAMES DOHERTY
NEW YORK, NY
NPI
1043875974
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NY 023899)
Enumeration Date
2019-05-06
Last Update Date
2020-09-18
Business Address
TREVOR JAMES DOHERTY
5141 BROADWAY # 2FW-095
NEW YORK, NY 10034-1159
Phone number: 212-932-5218
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Mailing Address
TREVOR JAMES DOHERTY
60 STILLSON RD
FAIRFIELD, CT 06825-3212
Phone number: 203-209-2106
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