Provider Demographics
NPI:1568126639
Name:CANNER, JAMES EDWARD JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:CANNER
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:928 BROADWAY STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-8156
Mailing Address - Country:US
Mailing Address - Phone:646-421-6064
Mailing Address - Fax:646-843-4701
Practice Address - Street 1:928 BROADWAY STE 301
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8156
Practice Address - Country:US
Practice Address - Phone:646-421-6064
Practice Address - Fax:646-843-4701
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY027588363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant