Healthcare Provider Details

I. General information

NPI: 1134737364
Provider Name (Legal Business Name): GIANCARLO VENTURA SCHILLACI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 EASTCHESTER RD
BRONX NY
10461-2301
US

IV. Provider business mailing address

1825 EASTCHESTER RD
BRONX NY
10461-2301
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-3333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027499-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: