Provider Demographics
NPI:1477683852
Name:TROYAN, MICHAEL A (RPA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:TROYAN
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 KERRY CT
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-5251
Mailing Address - Country:US
Mailing Address - Phone:631-708-6595
Mailing Address - Fax:
Practice Address - Street 1:1228 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2675
Practice Address - Country:US
Practice Address - Phone:631-603-3400
Practice Address - Fax:631-603-3401
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010977363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant