Healthcare Provider Details

I. General information

NPI: 1477683852
Provider Name (Legal Business Name): MICHAEL A TROYAN RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 E MAIN ST
RIVERHEAD NY
11901-2675
US

IV. Provider business mailing address

9 KERRY CT
RIVERHEAD NY
11901-5251
US

V. Phone/Fax

Practice location:
  • Phone: 631-603-3400
  • Fax: 631-603-3401
Mailing address:
  • Phone: 631-708-6595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010977
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: