Organization Name: | JOSEPH REALE PHYSICIAN ASSISTANT PC |
NPI Number: | 1013147800 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSEPH REALE (OWNER) |
Mailing Address: | 12 Alfred Ln Kings Park |
State: | NY US |
Postal Code: | 117545013 |
Phone Number: | 5165327805 |
Fax Number: | 9732914439 |
NPI Enumeration Date: | 07/15/2009 |
NPI Last Update Date: | 07/15/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 004677 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |