Individual
MRS. IDAMIS VASSALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4802 10TH AVENUE, BROOKLYN, NY 11219
(718) 283-6000
Mailing address
4802 10TH AVENUE, BROOKLYN, NY 11219
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
35350364
NY
Other
Enumeration date
04/09/2015
Last updated
04/09/2015
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