Healthcare Provider Details

I. General information

NPI: 1326579830
Provider Name (Legal Business Name): PAUL POIDOMANI D.O. (MAY 2017 GRAD)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MEETING HOUSE LN STE 403
SOUTHAMPTON NY
11968-7000
US

IV. Provider business mailing address

57 HAMPTON RD STE 201
SOUTHAMPTON NY
11968-4973
US

V. Phone/Fax

Practice location:
  • Phone: 631-283-2100
  • Fax:
Mailing address:
  • Phone: 631-283-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number310268
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number310268
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: