Healthcare Provider Details

I. General information

NPI: 1063741361
Provider Name (Legal Business Name): KATIE BROOKE GUARINO RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 FRANKLIN AVENUE SUITE 300
GARDEN CITY NY
11530
US

IV. Provider business mailing address

999 FRANKLIN AVENUE SUITE 300
GARDEN CITY NY
11530
US

V. Phone/Fax

Practice location:
  • Phone: 516-742-3404
  • Fax: 516-629-3857
Mailing address:
  • Phone: 516-742-3404
  • Fax: 516-629-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: