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1871101006
MARK GRANADOS
ROSLYN, NY
NPI
1871101006
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NY 025159)
Enumeration Date
2020-07-14
Last Update Date
2020-07-14
Business Address
MARK GRANADOS
100 PORT WASHINGTON BLVD
ROSLYN, NY 11576-1347
Phone number: 516-562-6000
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Mailing Address
MARK GRANADOS
195 ELM DR
BAY SHORE, NY 11706-2135
Phone number: 516-808-5932
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