Basic Information
| Provider Information | |||||||||
| NPI: | 1780336917 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIAN ASSISTANT ASSOCIATE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 998C OLD COUNTRY RD STE 132 | ||||||||
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| City: | PLAINVIEW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118034917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732406942 | ||||||||
| FaxNumber: | 5168274517 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 MONTAUK HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313763000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2022 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | MASCARELLI | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 5732406942 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PA | ||||||||
| NPICertificationDate: | 01/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.