Healthcare Provider Details

I. General information

NPI: 1386879161
Provider Name (Legal Business Name): CHIARA QUARESIMO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 OLD COUNTRY ROAD
PLAINVIEW NY
11803
US

IV. Provider business mailing address

294 ACRE LANE
HICKSVILLE NY
11801
US

V. Phone/Fax

Practice location:
  • Phone: 516-681-8822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number013185
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: