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General NPI Number Information
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NPI Number | 1699287722
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Entity Type | Organization
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Legal Business Name | SYOSSET OPTOMETRIC GROUP,PLLC
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 140 JACKSON AVE
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City | SYOSSET
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State | NY
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Zip | 11791-3802
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Country | US
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Telephone | 516-921-3580
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Fax |
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Provider Business Mailing Address
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Address Line | 140 JACKSON AVE
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City | SYOSSET
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State | NY
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Zip | 11791-3802
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Country | US
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Telephone | 516-921-3580
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRISTINA POLIZZI
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Credential | OD
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Telephone | 516-921-3580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State | NY
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