Provider Demographics
NPI:1063741361
Name:GUARINO, KATIE BROOKE (RPA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:BROOKE
Last Name:GUARINO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 FRANKLIN AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-742-3404
Mailing Address - Fax:516-629-3857
Practice Address - Street 1:999 FRANKLIN AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-742-3404
Practice Address - Fax:516-629-3857
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013558363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400055383Medicare PIN