Provider Demographics
NPI:1366497000
Name:SCHILLACI, PHILIP (PA)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:SCHILLACI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:PHILIP
Other - Middle Name:
Other - Last Name:SCHILLACI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:HUDSON VALLEY EMERGENCY MEDICINE PLLC
Mailing Address - City:POUGHKEEPAIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602
Mailing Address - Country:US
Mailing Address - Phone:610-668-6471
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:VASSAR BROTHERS MEDICAL CENTER
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-431-5624
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02445201Medicaid
NY02445201Medicaid
NY505961Medicare ID - Type Unspecified