Healthcare Provider Details

I. General information

NPI: 1083859573
Provider Name (Legal Business Name): DR. YOLANDA D. FRUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HILLSIDE AVE
WILLISTON PARK NY
11596-2343
US

IV. Provider business mailing address

85 HILLSIDE AVE
WILLISTON PARK NY
11596-2343
US

V. Phone/Fax

Practice location:
  • Phone: 516-746-3160
  • Fax:
Mailing address:
  • Phone: 516-746-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number041632
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: