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General NPI Number Information
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NPI Number | 1992738538
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Entity Type | Organization
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Legal Business Name | NEW YORK INSTITUTE OF TECHNOLOGY
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 267 CARLETON AVE
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City | CENTRAL ISLIP
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State | NY
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Zip | 11722-4543
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Country | US
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Telephone | 631-348-3254
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Fax | 631-348-3031
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Provider Business Mailing Address
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Address Line | 267 CARLETON AVE
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City | CENTRAL ISLIP
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State | NY
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Zip | 11722-4543
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Country | US
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Telephone | 631-348-3254
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Fax | 631-348-3031
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MS. PHYLLIS PUGLIESE
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Credential |
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Telephone | 516-686-3751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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