Healthcare Provider Details

I. General information

NPI: 1053888099
Provider Name (Legal Business Name): JOSEPH VOLLARO PHD NEUROPSYCHOLOGIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 LAKELAND AVE UNIT 12
BOHEMIA NY
11716-2174
US

IV. Provider business mailing address

1461 LAKELAND AVE UNIT 12
BOHEMIA NY
11716-2174
US

V. Phone/Fax

Practice location:
  • Phone: 631-732-4794
  • Fax: 631-732-0355
Mailing address:
  • Phone: 631-732-4794
  • Fax: 631-732-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOSEPH VOLLARO
Title or Position: OWNER
Credential: PHD
Phone: 631-732-4794