Individual
MR. JASON M LIGHTBODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3400 BAINBRIDGE AVE, 5TH FLOOR, BRONX, NY 10467
(718) 920-4896
Mailing address
216 PURCHASE ST APT K, RYE, NY 10580-2148
(914) 497-2606
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
011634
NY
Other
Enumeration date
11/30/2006
Last updated
02/10/2015
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