Provider Demographics
NPI:1619712312
Name:PILLARELLA, NICHOLAS RUDY (PA-C)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:RUDY
Last Name:PILLARELLA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8 BOYLE PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1202
Mailing Address - Country:US
Mailing Address - Phone:347-552-0445
Mailing Address - Fax:
Practice Address - Street 1:1820 STATE ROUTE 33 STE 4B
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4860
Practice Address - Country:US
Practice Address - Phone:732-776-8500
Practice Address - Fax:732-776-8946
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00871700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant