Provider Demographics
NPI:1275736217
Name:KISSOUS-HUNT, MICHELE (PA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:KISSOUS-HUNT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E 93RD ST
Mailing Address - Street 2:APT. 23D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5547
Mailing Address - Country:US
Mailing Address - Phone:212-410-2235
Mailing Address - Fax:212-369-2057
Practice Address - Street 1:1751 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6828
Practice Address - Country:US
Practice Address - Phone:212-369-2490
Practice Address - Fax:212-369-2057
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008576363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008576OtherNEW YORK STATE LICENSE #
NY1052968OtherNCCPA CERTIFICATION #
NY008576OtherNEW YORK STATE LICENSE #