Healthcare Provider Details

I. General information

NPI: 1295732196
Provider Name (Legal Business Name): DAWN BARILLI RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 10/11/2007

III. Provider practice location address

503 ROUTE 208
MONROE NY
10950-1619
US

IV. Provider business mailing address

503 ROUTE 208
MONROE NY
10950-1619
US

V. Phone/Fax

Practice location:
  • Phone: 845-783-2920
  • Fax:
Mailing address:
  • Phone: 845-783-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0067671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: