Healthcare Provider Details

I. General information

NPI: 1699287722
Provider Name (Legal Business Name): SYOSSET OPTOMETRIC GROUP,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 JACKSON AVE
SYOSSET NY
11791-3802
US

IV. Provider business mailing address

140 JACKSON AVE
SYOSSET NY
11791-3802
US

V. Phone/Fax

Practice location:
  • Phone: 516-921-3580
  • Fax:
Mailing address:
  • Phone: 516-921-3580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. CRISTINA POLIZZI
Title or Position: PRESIDENT
Credential: OD
Phone: 516-921-3580