# REGISTERED PHYSICIAN ASSISTANT FIRST ASSIST PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164753182
- **Authorized official:** MR. GENNADIY SHAMALOV RPA-C (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (917) 709-4733

## Contact information

- **Practice address:** 13876 QUEENS BLVD, 1ST FLOOR, BRIARWOOD, NY 11435-2930
- **Practice address phone:** (718) 850-6345
- **Mailing address:** 14123 HOOVER AVE, BRIARWOOD, NY 11435-1109
- **Mailing address phone:** (917) 709-4733

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | 008219 | NY | Yes |

## Other

- **Enumeration date:** 01/15/2010
- **Last updated:** 01/15/2010