Healthcare Provider Details

I. General information

NPI: 1801958459
Provider Name (Legal Business Name): LOUIS THOMAS VERARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 BELLEMEADE RD STONYBROOK FAMMED PC
SETAUKET NY
11733-3495
US

IV. Provider business mailing address

10 HAWTHORNE CT
CENTERPORT NY
11721-1717
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-5858
  • Fax: 631-444-1899
Mailing address:
  • Phone: 631-754-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number141828
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: