Healthcare Provider Details

I. General information

NPI: 1730278763
Provider Name (Legal Business Name): JOSEPH R ACCETTA JR. D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COURTHOUSE ROAD
FRANKLIN SQUARE NY
11010
US

IV. Provider business mailing address

100 COURTHOUSE ROAD
FRANKLIN SQUARE NY
11010
US

V. Phone/Fax

Practice location:
  • Phone: 516-488-8830
  • Fax: 516-488-8832
Mailing address:
  • Phone: 516-488-8830
  • Fax: 516-488-8832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: