Healthcare Provider Details

I. General information

NPI: 1659179968
Provider Name (Legal Business Name): VITO FACCILONGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 OLD COUNTRY RD
WESTBURY NY
11590-5156
US

IV. Provider business mailing address

338 SVAHN DR
VALLEY COTTAGE NY
10989-1608
US

V. Phone/Fax

Practice location:
  • Phone: 845-270-2066
  • Fax:
Mailing address:
  • Phone: 845-270-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: