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General NPI Number Information
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NPI Number | 1417421165
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Entity Type | Individual
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Provider Name | JUAN PAULO VERDAN BITANGA PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/16/2019
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 111 E 210TH ST
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City | BRONX
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State | NY
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Zip | 10467-2401
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Country | US
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Telephone | 718-920-4321
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Fax |
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Provider Business Mailing Address
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Address Line | 40 WATERSIDE PLZ APT 14J
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City | NEW YORK
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State | NY
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Zip | 10010-2637
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Country | US
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Telephone | 914-471-7126
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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