Healthcare Provider Details

I. General information

NPI: 1740679943
Provider Name (Legal Business Name): RENEE O'TOOLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD
GREAT NECK NY
11021-5206
US

IV. Provider business mailing address

700 HICKSVILLE RD STE 205
BETHPAGE NY
11714-3472
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-4128
  • Fax: 516-482-1822
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2914081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: