Individual
MS. AGNES SIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
560 NORTHERN BLVD, GREAT NECK, NY 11021-5118
(516) 487-6200
Mailing address
320 CARVEL AVE, CEDARHURST, NY 11516-1422
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001694
NY
363A00000X
Physician Assistant
Primary
011694
NY
Other
Enumeration date
08/11/2015
Last updated
08/11/2015
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