Provider Demographics
NPI:1740518489
Name:ADOLPHE, NATHALY Y (PA)
Entity type:Individual
Prefix:
First Name:NATHALY
Middle Name:Y
Last Name:ADOLPHE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 PARK AVE S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4301
Mailing Address - Country:US
Mailing Address - Phone:212-213-6155
Mailing Address - Fax:212-213-6188
Practice Address - Street 1:304 PARK AVE S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4301
Practice Address - Country:US
Practice Address - Phone:212-213-6155
Practice Address - Fax:212-213-6188
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013702363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical