Healthcare Provider Details

I. General information

NPI: 1235831496
Provider Name (Legal Business Name): ANDREA MARIE LOMUTI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD
STONY BROOK NY
11794-8434
US

IV. Provider business mailing address

101 NICOLLS RD
STONY BROOK NY
11794-8434
US

V. Phone/Fax

Practice location:
  • Phone: 631-638-8517
  • Fax:
Mailing address:
  • Phone: 631-638-8517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number347136
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: