Most Relevant Information
Provider Data
| NPI Number: | 1003660291 |
| Provider Name: | NIA GRANT PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 031616 |
Most Important Dates
| Enumeration Date: | 04/15/2024 |
| Last Updated: | 05/15/2024 |
Provider Practice Location
2510 30TH AVE
LONG ISLAND CITY
NY
111022448
Practice Location Phone/Fax
| Phone: | 7189321000 |
| Fax: |
Provider Mailing Location
186 13TH ST
BROOKLYN
NY
112154703
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |