Healthcare Provider Details

I. General information

NPI: 1629194840
Provider Name (Legal Business Name): JOANN T. PUTAGGIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SAINT ANDREWS LN
GLEN COVE NY
11542-2254
US

IV. Provider business mailing address

101 SAINT ANDREWS LN
GLEN COVE NY
11542-2254
US

V. Phone/Fax

Practice location:
  • Phone: 516-674-7390
  • Fax:
Mailing address:
  • Phone: 516-674-7390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number409067
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF301662
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: