Healthcare Provider Details

I. General information

NPI: 1013084763
Provider Name (Legal Business Name): DINA MARIE PUGLISSI RPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 NEW HYDE PARK RD
GARDEN CITY NY
11530-3909
US

IV. Provider business mailing address

46 PHIPPS AVE
EAST ROCKAWAY NY
11518-1403
US

V. Phone/Fax

Practice location:
  • Phone: 516-488-1313
  • Fax: 516-488-3449
Mailing address:
  • Phone: 516-593-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6403-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6403-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: