Provider Demographics
NPI:1699445130
Name:BEASCA, JOAQUIN TY (PA)
Entity type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:TY
Last Name:BEASCA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:56 BELLMORE ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3111
Mailing Address - Country:US
Mailing Address - Phone:929-378-8623
Mailing Address - Fax:
Practice Address - Street 1:56 BELLMORE ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3111
Practice Address - Country:US
Practice Address - Phone:929-378-8623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant