Provider Demographics
NPI:1891791919
Name:STORC, JAMES M (MPAS, RPA-C, RT(T))
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:STORC
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Gender:M
Credentials:MPAS, RPA-C, RT(T)
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Mailing Address - Street 1:100 HOSPITAL RD, SUITE 216
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-475-5511
Mailing Address - Fax:631-475-5544
Practice Address - Street 1:100 HOSPITAL RD, SUITE 216
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-475-5511
Practice Address - Fax:631-475-5544
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY009305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant