Individual
JAMIE WIDAWSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
259 1ST ST, MINEOLA, NY 11501-3957
(516) 663-8312
(516) 291-2184
Mailing address
259 1ST ST, MINEOLA, NY 11501-3957
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
015552-1
NY
Other
Enumeration date
05/08/2012
Last updated
04/02/2021
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