Individual
JUSTIN MICHAEL FALLACARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
707 E MAIN ST, MIDDLETOWN, NY 10940-2650
(845) 333-7575
(845) 333-7201
Mailing address
707 E MAIN ST, MIDDLETOWN, NY 10940-2650
(845) 333-7575
(845) 333-7201
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
024728
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06045005
—
NY
Enumeration date
09/11/2019
Last updated
10/16/2024
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