Healthcare Provider Details

I. General information

NPI: 1912020728
Provider Name (Legal Business Name): JOSEPH SIDOTI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 WOODBURY RD
PLAINVIEW NY
11803-1001
US

IV. Provider business mailing address

444 WOODBURY RD
PLAINVIEW NY
11803-1001
US

V. Phone/Fax

Practice location:
  • Phone: 516-983-6850
  • Fax: 516-942-7615
Mailing address:
  • Phone: 516-983-6850
  • Fax: 516-942-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043985
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: