Provider Demographics
NPI:1851538268
Name:SOLOMON, BETH ALLISON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ALLISON
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:ALLISON
Other - Last Name:SWEBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:630 W 168TH ST
Mailing Address - Street 2:PH 14 RM 104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-7771
Mailing Address - Fax:
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:PH 14 RM 104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-305-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013094363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant