Provider Demographics
NPI:1093284135
Name:GUARRELLA, JOSEPH ANTHONY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:GUARRELLA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:ANTHONY
Other - Last Name:GUARRELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6615 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3849
Mailing Address - Country:US
Mailing Address - Phone:917-538-3147
Mailing Address - Fax:
Practice Address - Street 1:6615 19TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3849
Practice Address - Country:US
Practice Address - Phone:718-837-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant