Provider Demographics
NPI:1598229742
Name:MARSILIO, JILLIAN NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:NICOLE
Last Name:MARSILIO
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3505 VETERANS MEMORIAL HWY STE C
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7613
Mailing Address - Country:US
Mailing Address - Phone:631-676-7656
Mailing Address - Fax:
Practice Address - Street 1:3505 VETERANS MEMORIAL HWY STE C
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7613
Practice Address - Country:US
Practice Address - Phone:631-676-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant