Healthcare Provider Details

I. General information

NPI: 1306549043
Provider Name (Legal Business Name): JILLIAN NOSTRO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 OLD COUNTRY RD
PLAINVIEW NY
11803-4914
US

IV. Provider business mailing address

73 8TH AVE
KINGS PARK NY
11754-4301
US

V. Phone/Fax

Practice location:
  • Phone: 516-719-2543
  • Fax:
Mailing address:
  • Phone: 631-626-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number334513
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: