Individual
MS. KAITLIN ANNE TERGESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3959 BROADWAY # CHN216, NEW YORK, NY 10032-1559
(212) 305-8402
Mailing address
3959 BROADWAY, CHN 216, NEW YORK, NY 10032
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04859358
—
NY
Enumeration date
07/19/2017
Last updated
03/09/2020
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