Individual
DIANA VLASOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
429 2ND AVE, NEW YORK, NY 10010-3101
(212) 726-6803
Mailing address
21 STERN CT, STATEN ISLAND, NY 10308-2158
(347) 983-4585
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004582-1
NY
Other
Enumeration date
10/02/2008
Last updated
10/02/2008
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