Individual
MARK VINCENT DE JESUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 E 77TH ST, NEW YORK, NY 10075-1850
(212) 434-2000
Mailing address
2543 HERING AVE, BRONX, NY 10469-5301
(718) 798-6592
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
12/04/2017
Last updated
12/04/2017
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