Provider Demographics
NPI:1427600907
Name:PARMELEE, ANDREW LARS (PA-C, MSHS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LARS
Last Name:PARMELEE
Suffix:
Gender:M
Credentials:PA-C, MSHS
Other - Prefix:MR
Other - First Name:ANDREW
Other - Middle Name:LARS
Other - Last Name:PARMELEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANDREW PARMELEE PA-C
Mailing Address - Street 1:170 W 74TH ST APT 809
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2354
Mailing Address - Country:US
Mailing Address - Phone:860-299-3424
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-630-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02361901363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant