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General NPI Number Information
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NPI Number | 1508484858
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Entity Type | Individual
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Provider Name | VIRGHINYA RIDWAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 900 FRANKLIN AVE
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City | VALLEY STREAM
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State | NY
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Zip | 11580-2145
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Country | US
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Telephone | 347-754-0141
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Fax |
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Provider Business Mailing Address
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Address Line | 8306 VIETOR AVE APT 1O
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City | ELMHURST
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State | NY
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Zip | 11373-3205
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Country | US
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Telephone |
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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 |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 025609
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License Number State | NY
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