MEDICARE: MICHELLE QUAGLINO RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	010764	NY

General Provider Information

NPI Number	:	1376562868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE QUAGLINO RPA-C

Provider Business Mailing Address
First Line	:	2130 72ND ST
Second Line	:	2ND FLOOR
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4487 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-1526
Country	:	US
Telephone Number	:	718-960-6127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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