Provider Demographics
NPI:1144471178
Name:RILEY, BROOKE W (RPA-C)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:W
Last Name:RILEY
Suffix:
Gender:F
Credentials:RPA-C
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Other - First Name:
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Mailing Address - Street 1:1220 NEW SCOTLAND RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9386
Mailing Address - Country:US
Mailing Address - Phone:518-439-4326
Mailing Address - Fax:518-439-6143
Practice Address - Street 1:1220 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9386
Practice Address - Country:US
Practice Address - Phone:518-439-4326
Practice Address - Fax:518-439-6143
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY012643363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant