Most Relevant Information
Provider Data
| NPI Number: | 1003180803 |
| Provider Name: | KENNETH BOMPAROLA PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 015373 |
Most Important Dates
| Enumeration Date: | 02/27/2012 |
| Last Updated: | 03/05/2014 |
Provider Practice Location
1901 1ST AVE
NEW YORK
NY
100297404
Practice Location Phone/Fax
| Phone: | 2124236262 |
| Fax: |
Provider Mailing Location
316 CARNATION RD
WEST ISLIP
NY
117952802
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |