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1952484719
IAN CARLO DEJESUS
BROOKLYN, NY
NPI
1952484719
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NY p47235)
Enumeration Date
2006-10-23
Last Update Date
2007-07-08
Business Address
-- IAN CARLO DEJESUS PA
760 BROADWAY
BROOKLYN, NY 11206-5317
Phone number: 171-896-3837
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Mailing Address
-- IAN CARLO DEJESUS PA
20936 27TH AVE
BAYSIDE, NY 11360-2405
Phone number: 718-428-2420
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