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Individual
FERRY FERDIANTO
Active
Individual
FERRY FERDIANTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA55394
CA
363AM0700X
Medical Physician Assistant
017304
NY
Other
Enumeration date
03/11/2014
Last updated
08/02/2023
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