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General NPI Number Information
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NPI Number | 1861434532
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Entity Type | Individual
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Provider Name | JOSE PUGLIESE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 70 GLEN ST SUITE 102
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City | GLEN COVE
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State | NY
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Zip | 11542-2855
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Country | US
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Telephone | 516-609-9294
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Fax |
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Provider Business Mailing Address
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Address Line | 7 SUGAR MAPLE CT
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City | DIX HILLS
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State | NY
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Zip | 11746-6249
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Country | US
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Telephone | 631-254-6976
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 197269
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License Number State | NY
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