Provider Demographics
NPI:1053160952
Name:DELLARAGIONE, RACHEL JULIENNE (PA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JULIENNE
Last Name:DELLARAGIONE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:184 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6006
Mailing Address - Country:US
Mailing Address - Phone:631-241-1449
Mailing Address - Fax:
Practice Address - Street 1:600 NORTHERN BLVD STE 310
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5200
Practice Address - Country:US
Practice Address - Phone:516-321-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031640-01363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical