Doctor Name: | JOY MERRY BLACK |
NPI Number: | 1881786515 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RPA-C |
License Number: | 004974 |
Business Practice Address: | 1772 Helderberg Trl Berne, NY - 120232709 |
Business Phone Number: | 5188729262 |
Business Fax Number: | 5188729265 |
Mailing Address: | 1772 Helderberg Trl, BERNE |
State: | NY |
Postal Code: | 120232709 |
Phone Number: | 5188729262 |
Fax Number: | 5188729265 |
NPI Enumeration Date: | 09/29/2006 |
NPI Last Update Date: | 07/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 004974 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |