Healthcare Provider Details

I. General information

NPI: 1225161284
Provider Name (Legal Business Name): GREGORY PUGLISI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 OLD COUNTRY RD 5
PLAINVIEW NY
11803-5022
US

IV. Provider business mailing address

1171 OLD COUNTRY RD 5
PLAINVIEW NY
11803-5022
US

V. Phone/Fax

Practice location:
  • Phone: 516-938-7676
  • Fax: 516-938-7718
Mailing address:
  • Phone: 516-938-7676
  • Fax: 516-938-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number243050
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier243050
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: