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General NPI Number Information
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NPI Number | 1114249786
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Entity Type | Individual
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Provider Name | GISELLE RENDON PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 27005 76TH AVE
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1402
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Country | US
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Telephone | 718-470-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 9610 40TH RD FL 2
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City | CORONA
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State | NY
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Zip | 11368-2139
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Country | US
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Telephone | 917-515-9299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 013873
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License Number State | NY
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