Healthcare Provider Details

I. General information

NPI: 1659567980
Provider Name (Legal Business Name): JOHN V. CELENTANO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 MONTAUK HIGHWAY SUITE 1
E. MORICHES NY
11940-1239
US

IV. Provider business mailing address

516-1 MONTAUK HIGHWAY
E. MORICHES NY
11940-1239
US

V. Phone/Fax

Practice location:
  • Phone: 631-874-4230
  • Fax: 631-874-2948
Mailing address:
  • Phone: 631-874-4230
  • Fax: 631-874-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN CELENTANO
Title or Position: DIRECTOR
Credential: M.D.
Phone: 631-874-2900