Healthcare Provider Details

I. General information

NPI: 1609789908
Provider Name (Legal Business Name): ANDREW ROBERT CAMPAGNUOLO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 FREMONT ST
LINDENHURST NY
11757-3806
US

IV. Provider business mailing address

59 FREMONT ST
LINDENHURST NY
11757-3806
US

V. Phone/Fax

Practice location:
  • Phone: 516-450-1110
  • Fax:
Mailing address:
  • Phone: 516-450-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: