Healthcare Provider Details

I. General information

NPI: 1710991070
Provider Name (Legal Business Name): FRANK JOSEPH ADIPIETRO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BOISSEAU AVENUE
SOUTHOLD NY
11971-1196
US

IV. Provider business mailing address

700 BOISSEAU AVE
SOUTHOLD NY
11971-0727
US

V. Phone/Fax

Practice location:
  • Phone: 631-477-5353
  • Fax: 631-477-5891
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 Number1585321
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: