Provider Demographics
NPI:1679713325
Name:PASQUARELLO, KRISTIN MICHELE (RPA-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELE
Last Name:PASQUARELLO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MICHELE
Other - Last Name:MAIDHOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:1484 MIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:161 FORT WASHINGTON AVE
Practice Address - Street 2:HIP 5TH FLOOR, CIVT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-342-3622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012950363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant