Individual
ANGENIE PREVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2510 30TH AVE, LONG ISLAND CITY, NY 11102-2448
(718) 932-7151
Mailing address
10 COLSON WAY, RANDOLPH, MA 02368-2752
(857) 991-6077
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA4396
MA
Other
Enumeration date
08/21/2012
Last updated
08/21/2012
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