Healthcare Provider Details

I. General information

NPI: 1124946298
Provider Name (Legal Business Name): CHRISTOPHER PERNICIARO HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E MONTAUK HWY STE 27
EAST PATCHOGUE NY
11772-3154
US

IV. Provider business mailing address

73 ALAN ST
EAST ISLIP NY
11730-2802
US

V. Phone/Fax

Practice location:
  • Phone: 631-333-7865
  • Fax:
Mailing address:
  • Phone: 631-334-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14000082337
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: