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General NPI Number Information
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NPI Number | 1851815716
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Entity Type | Individual
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Provider Name | TIMOTHY PATRICK AIELLO NPP
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Gender | Male
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 08/01/2017
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Provider Practice Location Address
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Address Line | 363 ROUTE 111
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City | SMITHTOWN
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State | NY
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Zip | 11787-4756
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Country | US
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Telephone | 631-848-1968
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Fax |
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Provider Business Mailing Address
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Address Line | 938 COATES AVE
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City | HOLBROOK
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State | NY
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Zip | 11741-6025
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Country | US
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Telephone | 631-312-1362
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 402205
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License Number State | NY
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