Organization
REGISTERED PHYSICIAN ASSISTANT FIRST ASSIST PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GENNADIY SHAMALOV RPA-C (PHYSICIAN ASSISTANT)
(917) 709-4733
Entity
Organization
Contact information
Practice address
13876 QUEENS BLVD, 1ST FLOOR, BRIARWOOD, NY 11435-2930
(718) 850-6345
Mailing address
14123 HOOVER AVE, BRIARWOOD, NY 11435-1109
(917) 709-4733
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
008219
NY
Other
Enumeration date
01/15/2010
Last updated
01/15/2010
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