Healthcare Provider Details

I. General information

NPI: 1326071556
Provider Name (Legal Business Name): LOURDES PILETA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BAYSHORE ROAD
NORTH BABYLON NY
11703
US

IV. Provider business mailing address

55 WATER STREET 2ND FLOOR CRED DEPT
NEW YORK NY
10041-0004
US

V. Phone/Fax

Practice location:
  • Phone: 631-586-2700
  • Fax: 631-491-8613
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number236912
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: