Healthcare Provider Details

I. General information

NPI: 1043074453
Provider Name (Legal Business Name): EMILY FIDILIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2182 AMSTERDAM AVE
NEW YORK NY
10032-2433
US

IV. Provider business mailing address

1706 SHORE BLVD
BROOKLYN NY
11235-2323
US

V. Phone/Fax

Practice location:
  • Phone: 917-388-3858
  • Fax:
Mailing address:
  • Phone: 347-267-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number071246
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: