Provider Demographics
NPI:1851427603
Name:GRIFFIN, DAVID J (PA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:168 BOHON RD
Mailing Address - Street 2:
Mailing Address - City:CHURUBUSCO
Mailing Address - State:NY
Mailing Address - Zip Code:12923-1714
Mailing Address - Country:US
Mailing Address - Phone:518-897-2317
Mailing Address - Fax:518-897-2317
Practice Address - Street 1:2233 STATE ROUTE 86
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5644
Practice Address - Country:US
Practice Address - Phone:518-897-2317
Practice Address - Fax:518-897-2423
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005850-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005850OtherPA LICENSE NUMBER
NY005850OtherPA LICENSE NUMBER
NYMG0494447OtherDEA
NY005850OtherPA LICENSE NUMBER