Provider Demographics
NPI:1386367977
Name:BAVARO, JAMES FRANK I (PA-C)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:FRANK
Last Name:BAVARO
Suffix:I
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:142 SHIEL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-4280
Mailing Address - Country:US
Mailing Address - Phone:718-689-2975
Mailing Address - Fax:
Practice Address - Street 1:3333 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3608
Practice Address - Country:US
Practice Address - Phone:718-667-7500
Practice Address - Fax:718-667-0391
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
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Provider Licenses
StateLicense IDTaxonomies
NY118040-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant