Individual
FREDERICK PATRICK KAVANAGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPA-C
Contact information
Practice address
1869 BRENTWOOD RD, BRENTWOOD, NY 11717-4625
(631) 853-3400
Mailing address
2 GRAND ST, LAKE RONKONKOMA, NY 11779-1715
(631) 738-7417
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006209-1
NY
Other
Enumeration date
09/27/2006
Last updated
07/08/2007
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