MEDICARE: FABIO COLLARELLI 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	008143	NY
2	363A00000X	Physician Assistant	25MP00987800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548206105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABIO COLLARELLI RPA-C

Provider Business Mailing Address
First Line	:	30 HATFIELD LN STE 201
Second Line	:
City	:	GOSHEN
State	:	NY
Zip	:	10924-6768
Country	:	US
Telephone Number	:	845-294-3446
Fax Number	:	845-294-4171

Provider Business Practice Location Address
First Line	:	1900 UNION VALLEY RD STE 305
Second Line	:
City	:	HEWITT
State	:	NJ
Zip	:	07421-3024
Country	:	US
Telephone Number	:	201-639-6620
Fax Number	:	201-972-8980

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	01/15/2026

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Directions to “ FABIO COLLARELLI RPA-C” Practice Location

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