Healthcare Provider Details

I. General information

NPI: 1275964470
Provider Name (Legal Business Name): ANNETTE FIORILLO, DO P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 LINCOLN AVE #200
OCEANSIDE NY
11572-2195
US

IV. Provider business mailing address

2940 LINCOLN AVE #200
OCEANSIDE NY
11572
US

V. Phone/Fax

Practice location:
  • Phone: 516-307-9140
  • Fax: 516-706-6770
Mailing address:
  • Phone: 516-307-9140
  • Fax: 516-706-6770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number243388
License Number StateNY

VIII. Authorized Official

Name: DR. ANNETTE LOUISE FIORILLO
Title or Position: PROVIDER
Credential: DO, PC
Phone: 516-307-9140