Individual
JOHN MIRASOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
560 WEST 168TH STREET, NEW YORK, NY 10032
(212) 305-4318
Mailing address
15 AVALON COURT, STATEN ISLAND, NY 10303
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
679048
NY
Other
Enumeration date
06/26/2023
Last updated
06/26/2023
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