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STATEN ISLAND, NY
NPI1053933143
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363AS0400X Physician Assistant Surgical
(Licence: NY  025243)
Enumeration Date2020-05-12
Last Update Date2020-07-30
Business Address
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1 CAMPUS RD
STATEN ISLAND, NY 10301-4495
Phone number: 718-619-1995
Mailing Address
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512 VALLEYVIEW PL
STATEN ISLAND, NY 10314-5535
Phone number: 718-619-1995