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NPI Code Detail

MEDICARE: JESSICA MARIE RALLO PA-C

MEDICARE: JESSICA MARIE RALLO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant033268NY

General Provider Information

NPI Number : 1538922612
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MARIE RALLO PA-C
Provider Business Mailing Address
First Line : 707 E MAIN ST
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10940-2650
Country : US
Telephone Number : 845-333-7575
Fax Number :
Provider Business Practice Location Address
First Line : 707 E MAIN ST
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10940-2650
Country : US
Telephone Number : 845-333-7575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2024
Last Update Date : 05/20/2026

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Directions to “ JESSICA MARIE RALLO PA-C” Practice Location

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