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General NPI Number Information
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NPI Number | 1780336917
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Entity Type | Organization
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Legal Business Name | PHYSICIAN ASSISTANT ASSOCIATE PLLC
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 1000 MONTAUK HIGHWAY
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City | WEST ISLIP
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State | NY
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Zip | 11795
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Country | US
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Telephone | 631-376-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 998C OLD COUNTRY RD STE 132
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City | PLAINVIEW
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State | NY
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Zip | 11803-4917
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Country | US
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Telephone | 573-240-6942
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Fax | 516-827-4517
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MR. ROBERT MASCARELLI
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Credential | PA
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Telephone | 573-240-6942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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