Provider Demographics
NPI:1962726265
Name:HOM, VINITA (RPA-C)
Entity type:Individual
Prefix:MS
First Name:VINITA
Middle Name:
Last Name:HOM
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:136-20 38TH AVENUE
Mailing Address - Street 2:SUITE #5H
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-661-9554
Mailing Address - Fax:718-661-9556
Practice Address - Street 1:13620 38TH AVE
Practice Address - Street 2:SUITE #5H
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4233
Practice Address - Country:US
Practice Address - Phone:718-661-9554
Practice Address - Fax:718-661-9556
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY012315363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical