MEDICARE: NEIL LOUIS BELLET MD

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	207N00000X	Dermatology Physician	12747310 1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1129	OTHER		VYTRA

General Provider Information

NPI Number	:	1457368292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL LOUIS BELLET MD

Provider Business Mailing Address
First Line	:	53 BRENTWOOD RD
Second Line	:	SUITE D
City	:	BAY SHORE
State	:	NY
Zip	:	11706-6943
Country	:	US
Telephone Number	:	631-665-0328
Fax Number	:	631-665-0371

Provider Business Practice Location Address
First Line	:	53 BRENTWOOD RD
Second Line	:	SUITE D
City	:	BAY SHORE
State	:	NY
Zip	:	11706-6943
Country	:	US
Telephone Number	:	631-665-0328
Fax Number	:	631-665-0371

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	02/04/2016

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