STEPHEN MATTHEW MACIOCH Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006707

License Status

NOT RENEWED

Business

First Name

STEPHEN

Middle

MATTHEW

Last Name

MACIOCH

Business Name

STEPHEN MATTHEW MACIOCH

Original Issue Date

08/15/2018

Effective Date

12/24/2019

Expiration Date

03/01/2022

City

ASTORIA

State

Zip

11103

County

NEW YORK

Ever Disciplined

LastModifiedDate

07/27/2022