Provider Demographics
NPI:1649327073
Name:GRIFFIN, NEIL (PA-C)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:605 41ST ST
Mailing Address - Street 2:#M
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-3167
Mailing Address - Country:US
Mailing Address - Phone:718-851-5173
Mailing Address - Fax:718-579-4822
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-6010
Practice Address - Fax:718-579-4822
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003631-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant