Healthcare Provider Details

I. General information

NPI: 1467948299
Provider Name (Legal Business Name): TAYLOR BATTAGLIA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2018
Last Update Date: 07/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 OLD COUNTRY RD STE K-L
RIVERHEAD NY
11901-2115
US

IV. Provider business mailing address

1907 COBBLESTONE CT
MIDDLE ISLAND NY
11953-1472
US

V. Phone/Fax

Practice location:
  • Phone: 631-727-2858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number008834
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: