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General NPI Number Information
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NPI Number | 1205969573
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Entity Type | Organization
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Legal Business Name | DR.MADELINE PUGLIESE D.O. PLLC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 211 MAIN ST
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-3211
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Country | US
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Telephone | 516-944-8555
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Fax | 516-944-0387
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Provider Business Mailing Address
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Address Line | 211 MAIN ST
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-3211
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Country | US
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Telephone | 516-944-8555
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Fax | 516-944-0387
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Authorized Official
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Title or Position | OWNER
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Name | DR. MADELINE MELISSA PUGLIESE
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Credential | D.O
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Telephone | 516-944-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 196346
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License Number State | NY
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