Healthcare Provider Details

I. General information

NPI: 1104568203
Provider Name (Legal Business Name): EMILY A PASSARELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

19 SKYLINE DR
HAWTHORNE NY
10532-2134
US

V. Phone/Fax

Practice location:
  • Phone: 914-594-2110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number344992
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: