Individual
MRS. ASTRID THALIA JEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-4321
Mailing address
3411 WAYNE AVE, APT 8L, BRONX, NY 10467-2509
(347) 879-5978
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
015363
NY
Other
Enumeration date
10/05/2012
Last updated
11/08/2018
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