MEDICARE: JOSEPH VOLLARO PH.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	103G00000X	Clinical Neuropsychologist	015182	NY

General Provider Information

NPI Number	:	1578659058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH VOLLARO PH.D.

Provider Business Mailing Address
First Line	:	1461 LAKELAND AVE UNIT 12
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-2174
Country	:	US
Telephone Number	:	631-732-4794
Fax Number	:	631-732-0355

Provider Business Practice Location Address
First Line	:	1461 LAKELAND AVE UNIT 12
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-2174
Country	:	US
Telephone Number	:	631-732-4794
Fax Number	:	631-732-0355

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	10/23/2018

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