Healthcare Provider Details

I. General information

NPI: 1477559748
Provider Name (Legal Business Name): MICHAEL T PUGLIESE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 DEER PARK AVE
BABYLON NY
11702-1314
US

IV. Provider business mailing address

655 DEER PARK AVE
BABYLON NY
11702-1314
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-2100
  • Fax: 631-321-2246
Mailing address:
  • Phone: 631-321-2100
  • Fax: 631-321-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number141399
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: