Provider Demographics
NPI:1164031878
Name:HANDWERK, LOGAN MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:MICHAEL
Last Name:HANDWERK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 W 25TH ST FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7265
Mailing Address - Country:US
Mailing Address - Phone:212-253-2968
Mailing Address - Fax:212-253-2953
Practice Address - Street 1:147 W 25TH ST FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7265
Practice Address - Country:US
Practice Address - Phone:212-253-2968
Practice Address - Fax:212-253-2953
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2022-03-24
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant