MEDICARE: DR. ELENI BACOLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	91171	NY

General Provider Information

NPI Number	:	1154432433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELENI BACOLA M.D.

Provider Business Mailing Address
First Line	:	11 SKYVIEW LN
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-1817
Country	:	US
Telephone Number	:	631-751-0600
Fax Number	:	631-751-6526

Provider Business Practice Location Address
First Line	:	2500 NESCONSET HWY BLDG 10D
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2553
Country	:	US
Telephone Number	:	631-751-0600
Fax Number	:	631-751-6526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/25/2026

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