Provider Demographics
NPI:1396988234
Name:PIRRO-RADEOS, ANNMARIE (PA)
Entity type:Individual
Prefix:MS
First Name:ANNMARIE
Middle Name:
Last Name:PIRRO-RADEOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:DORINA
Other - Last Name:PIRR-RADEOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:56-45 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-445-0220
Mailing Address - Fax:718-939-1167
Practice Address - Street 1:56-45 MAIN STREET
Practice Address - Street 2:W-LL300
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-445-0220
Practice Address - Fax:718-661-1167
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010576363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400018382Medicare UPIN