Individual
KEVIN LLIGUISUPA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1752 FRANCIS LEWIS BLVD, WHITESTONE, NY 11357-3247
(718) 746-9494
Mailing address
1752 FRANCIS LEWIS BLVD, WHITESTONE, NY 11357-3247
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
033239
NY
Other
Enumeration date
02/13/2025
Last updated
02/13/2025
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