Provider Demographics
NPI:1245479476
Name:PILLEN, JOHN STUART (RPA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STUART
Last Name:PILLEN
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ATWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326
Mailing Address - Country:US
Mailing Address - Phone:607-547-3981
Mailing Address - Fax:
Practice Address - Street 1:1 ATWELL ROAD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326
Practice Address - Country:US
Practice Address - Phone:607-547-3981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1085311363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant