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Diana Gavrilov, PA

Physician Assistant, Medical in New Hyde Park, NY. Individual provider (NPI-1).

NPI number1316067390
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1316067390
Entity type
Individual (NPI-1)
Name
Diana Gavrilov
Credential
PA
Sex
Female
Sole proprietor
Yes
Enumeration date
Mar 31, 2007
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363AM0700X Physician Assistant, Medical006024NYYes

Practice location

27005 76th Ave
New Hyde Park, NY 11040-1433

Phone 718-470-7331

Mailing address

972 Brush Hollow Rd
Westbury, NY 11590-1740

Phone 516-876-5555 · Fax 516-876-1246

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