MEDICARE: PHYSICIAN ASSISTANT CONSULTING PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1841774403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN ASSISTANT CONSULTING PC

Provider Business Mailing Address
First Line	:	24 CHARTER AVE
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-6447
Country	:	US
Telephone Number	:	718-554-1042
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 CHARTER AVE
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-6447
Country	:	US
Telephone Number	:	718-554-1042
Fax Number	:

Authorized Official
Title or Position	:	BILLER
Name	:	VARUN BAJAJ
Credential	:
Telephone Number	:	718-554-1042

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	11/12/2018

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