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General NPI Number Information
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NPI Number | 1790429660
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Entity Type | Individual
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Provider Name | JANET DIBARTOLO
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Gender | Female
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 640 BELLE TERRE RD BLDG J
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1936
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Country | US
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Telephone | 631-828-5361
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Fax |
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Provider Business Mailing Address
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Address Line | 640 BELLE TERRE RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1936
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Country | US
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Telephone | 917-596-7996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 013117
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License Number State | NY
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