Healthcare Provider Details

I. General information

NPI: 1740254937
Provider Name (Legal Business Name): JOHN FRANCIS BISACCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BAY SHORE RD
NORTH BABYLON NY
11703-2823
US

IV. Provider business mailing address

55 WATER ST 12TH FLOOR CREDENTIALING
NEW YORK NY
10041-0004
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1625261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: