Individual
INGRID DEFREITAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3175 23RD ST, ASTORIA, NY 11106-4134
(516) 542-6880
(516) 542-5556
Mailing address
3175 23RD ST, ASTORIA, NY 11106-4134
(516) 542-6880
(516) 542-5556
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
010128
NY
Other
Enumeration date
03/31/2007
Last updated
10/19/2012
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