Healthcare Provider Details

I. General information

NPI: 1649808841
Provider Name (Legal Business Name): DOMINICK VINCENT CONGIUSTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 BRENTWOOD RD STE 100
BAY SHORE NY
11706-6924
US

IV. Provider business mailing address

46 BRENTWOOD RD STE 100
BAY SHORE NY
11706-6924
US

V. Phone/Fax

Practice location:
  • Phone: 888-495-1259
  • Fax:
Mailing address:
  • Phone: 888-495-1259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number344282-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: