NPI 1215867619

Jesse Ryan Banham, PAC

Practitioner Physician Assistant Ozone Park, NY

Practice location

Address: 8304a 101st Ave, Ozone Park, NY 11416-2059
Phone: (718) 772-6012

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X

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Registry record

NPI: 1215867619
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 May 2026
Record last updated: 19 May 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.