Leah Gustavson PA

NPI 1730197773 - Physician Assistant - 363A00000X

NPI Details
NPI 1730197773
Gender Female
Enumeration Date 08/04/2006
Last Updated 11/09/2012
Entity Type Individual
Active Over 10 years ago
Practice Location
763 LARKFIELD RD
COMMACK NY, 11725-3131, US
Phone (631) 462-2225
Fax
Business Location
763 LARKFIELD RD
COMMACK NY, 11725-3131, US
Phone (631) 462-2225
Fax
Toxanomy
Taxonomy Code 363A00000X
License State Florida
License Number PA 9105115
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According to our database, Ms. Leah Gustavson PA NPI is 1730197773, taxonomy code is 363A00000X and license number is PA 9105115, license state is located at Florida. Leah Gustavson PA physically located at 763 Larkfield Rd, Commack NY, 11725-3131. NPI Number Leah Gustavson PA has the Individual type.

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1730197773 NPI number is provided on an as is basis without warranty of any kind. 1730197773 is maintained by the National Plan & Provider Enumeration System. The contents of Leah Gustavson PA are for informational purposes only.