Healthcare Provider Details

I. General information

NPI: 1043242258
Provider Name (Legal Business Name): RICHARD J DAGOSTINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD STE 300
GREAT NECK NY
11021
US

IV. Provider business mailing address

600 NORTHERN BLVD STE 300
GREAT NECK NY
11021
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-8717
  • Fax: 516-365-1634
Mailing address:
  • Phone: 516-627-8717
  • Fax: 516-365-1634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number157112
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: