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General NPI Number Information
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NPI Number | 1740481928
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Entity Type | Individual
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Provider Name | BENEDETTA PRUNELLA LERCH PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 88-25 153RD STREET
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City | JAMAICA
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State | NY
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Zip | 11432-0000
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Country | US
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Telephone | 718-558-7239
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Fax | 718-459-5349
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Provider Business Mailing Address
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Address Line | 8 VINE STREET P. O. BOX 596
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City | GLENWOOD LANDING
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State | NY
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Zip | 11547-0000
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Country | US
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Telephone | 516-759-2472
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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 | 003251-1
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License Number State | NY
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