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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

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Active Sole Proprietor

Surgical Physician Assistant · STATEN ISLAND, NY

Registration Details

NPI Number
1053933143
Provider Type
Individual
Gender
Male
NPI Issued
May 12, 2020 (5.9427338770765 yrs)
Last Updated
Jul 30, 2020
License
025243 (NY)
Sole Proprietor
Yes

Practice Information

Address
1 CAMPUS RD
STATEN ISLAND, NY, 103014495
Browse NY providers · Browse ZIP 10301
Phone
7186191995
Primary Specialty
Surgical Physician Assistant
363AS0400X

Other Surgical Physician Assistant Providers in STATEN ISLAND, NY

Name Credential NPI
MR. PHILIP SALVATORE PATERNO P.A.-C. 1558334128
MRS. AMY MATTIELLI P.A.-C. 1013980606
MR. CHRISTOPHER H GANGOO PA 1871560151
MR. JOHN ANTHONY DELLA CHIESA PA-C 1326133117
MRS. KRISTY DYANN LUBAK PA 1689702292
MISS PATRICIA M O'KEEFE P.A. 1124144241
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.