Individual
CAM HA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1300 YORK AVE, NEW YORK, NY 10065-4805
(212) 746-5454
Mailing address
2928 JEROME AVE APT 1A, BRONX, NY 10468-1659
(347) 633-8991
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/20/2018
Last updated
02/20/2018
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