Individual
FALLON VICTORIA ETKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1783 ROUTE 9 STE 204, HALFMOON, NY 12065-2466
(518) 371-9355
(518) 373-9139
Mailing address
711 TROY SCHENECTADY RD STE 203, LATHAM, NY 12110-2461
(518) 782-3700
(518) 782-3799
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
025188
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06679469
—
NY
Enumeration date
07/20/2020
Last updated
10/02/2023
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