Provider Demographics
NPI:1912518184
Name:PHUA, JONATHAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:PHUA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 NEW HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1206
Mailing Address - Country:US
Mailing Address - Phone:516-326-2599
Mailing Address - Fax:
Practice Address - Street 1:3003 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1206
Practice Address - Country:US
Practice Address - Phone:516-326-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical