=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760468847
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANTO J FIUMANO DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2005
-----------------------------------------------------
Last Update Date | 12/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 SOUTH WELLWOOD AVENUE
-----------------------------------------------------
City | LINDENHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-226-8600
-----------------------------------------------------
Fax | 631-957-7858
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 502 SOUTH WELLWOOD AVENUE
-----------------------------------------------------
City | LINDENHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-226-8600
-----------------------------------------------------
Fax | 631-957-7858
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 202755
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------