MS. Leah Gustavson, PA

NPI #1730197773 in Commack, New York

Provider Information

NPI Number: 1730197773
Entity Type: Individual
Name: MS. Leah Gustavson, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Aug 4, 2006
Last Updated: Nov 9, 2012

Practice Location

Address: 763 LARKFIELD RD
City: Commack
State: New York
ZIP Code: 11725-3131
Phone: (631) 462-2225

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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