Provider Demographics
NPI:1720240617
Name:NORTON, NEAL DAVID JR (PA)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:DAVID
Last Name:NORTON
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3522
Mailing Address - Country:US
Mailing Address - Phone:518-276-6287
Mailing Address - Fax:518-276-8573
Practice Address - Street 1:110 8TH ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-276-6287
Practice Address - Fax:518-276-8573
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012599363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03034815Medicaid
NYPA2670Medicare PIN