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NPI Code Detail

MEDICARE: MS. MARIA LISA PALLOTTA PA

MEDICARE: MS. MARIA LISA PALLOTTA PA
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
1363A00000XPhysician Assistant006675NY

General Provider Information

NPI Number : 1528185675
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIA LISA PALLOTTA PA
Provider Business Mailing Address
First Line : 138 OGORMAN AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-3737
Country : US
Telephone Number : 718-987-9445
Fax Number :
Provider Business Practice Location Address
First Line : 4802 10TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-2916
Country : US
Telephone Number : 718-283-6000
Fax Number : 718-283-8261
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 03/17/2026

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