Provider Demographics
NPI:1346572492
Name:GEORGE, LYNETTE D (PA-C)
Entity type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:D
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LYNETTE
Other - Middle Name:D
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:3105 NEW ENGLAND THRUWAY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3141
Mailing Address - Country:US
Mailing Address - Phone:917-378-3184
Mailing Address - Fax:
Practice Address - Street 1:3105 NEW ENGLAND THRUWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3141
Practice Address - Country:US
Practice Address - Phone:917-378-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-31
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant