Randall, Phyllis Elaine

Randall, Phyllis Elaine is an individual health care provider with primary practice located at 3 Charles St , Pleasant Valley NY 12569-7703. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Randall, Phyllis Elaine can be contacted via phone (845) 635-2650.

Contact Information

Primary practice address
3 Charles St Pleasant Valley NY 12569-7703
Phone: (845) 635-2650
Fax: (845) 635-2433
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 001537 New York

Profile Details

NPI number 1235162892
LBN Legal business name Randall, Phyllis Elaine
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 8th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235162892 NPPES
New York MEDICAID 02389086

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