Provider Demographics
NPI:1205563665
Name:GUGLIELMO, RITA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:GUGLIELMO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16135 84TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3316
Mailing Address - Country:US
Mailing Address - Phone:718-710-0981
Mailing Address - Fax:
Practice Address - Street 1:8223 153RD AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1751
Practice Address - Country:US
Practice Address - Phone:718-845-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2023-01-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant