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General NPI Number Information
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NPI Number | 1952571572
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Entity Type | Organization
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Legal Business Name | JOHN FIORDALISI MD PLLC
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 166 E 88TH ST
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City | NEW YORK
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State | NY
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Zip | 10128-2255
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Country | US
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Telephone | 646-406-5404
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Fax |
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Provider Business Mailing Address
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Address Line | 35 HAMPTON BAYS DR
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City | HAMPTON BAYS
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State | NY
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Zip | 11946-3007
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Country | US
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Telephone | 646-406-5404
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Fax | 718-320-7225
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Authorized Official
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Title or Position | ANESTHESIOLOGY
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Name | DR. JOHN FIORDALISI
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Credential | MD
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Telephone | 646-406-5404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 169238
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License Number State | NY
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