Provider Demographics
NPI:1043628068
Name:MCNULTY, JILLIAN ROSE (PA)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:ROSE
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JILLIAN
Other - Middle Name:ROSE
Other - Last Name:SPALLINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:480 SOUTH BEDFORD ROAD
Mailing Address - Street 2:PRE-SURGICAL TESTING BUILDING C
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514
Mailing Address - Country:US
Mailing Address - Phone:914-458-8850
Mailing Address - Fax:914-458-8764
Practice Address - Street 1:480 SOUTH BEDFORD ROAD
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514
Practice Address - Country:US
Practice Address - Phone:914-458-8863
Practice Address - Fax:914-458-8764
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13781002OtherCAQH