Healthcare Provider Details

I. General information

NPI: 1114190691
Provider Name (Legal Business Name): FRANK J ADIPIETRO JR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BOISSEAU AVENUE
SOUTHOLD NY
11971
US

IV. Provider business mailing address

700 BOISSEAU AVE
SOUTHOLD NY
11971-2926
US

V. Phone/Fax

Practice location:
  • Phone: 631-477-5353
  • Fax: 631-477-5353
Mailing address:
  • Phone: 631-477-5353
  • Fax: 631-477-5891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number158532-1
License Number StateNY

VIII. Authorized Official

Name: FRANK J ADIPIETRO JR.
Title or Position: OWNER
Credential: MD
Phone: 631-477-5353