Provider Demographics
NPI:1417360249
Name:CILLI, NOELIA (PA-C)
Entity Type:Individual
Prefix:
First Name:NOELIA
Middle Name:
Last Name:CILLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 74TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5603
Mailing Address - Country:US
Mailing Address - Phone:718-651-7000
Mailing Address - Fax:
Practice Address - Street 1:4037 74TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5603
Practice Address - Country:US
Practice Address - Phone:718-651-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017553363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant