Provider Demographics
NPI:1013194174
Name:PETER TAORMINO
Entity Type:Organization
Organization Name:PETER TAORMINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAORMINO
Authorized Official - Suffix:
Authorized Official - Credentials:SPOUSE
Authorized Official - Phone:631-467-2813
Mailing Address - Street 1:622 HAWKINS AVE
Mailing Address - Street 2:STE 8
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-2374
Mailing Address - Country:US
Mailing Address - Phone:631-467-2813
Mailing Address - Fax:631-467-1417
Practice Address - Street 1:622 HAWKINS AVE
Practice Address - Street 2:STE 8
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2374
Practice Address - Country:US
Practice Address - Phone:631-467-2813
Practice Address - Fax:631-467-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4002120001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4002120001Medicare NSC
NYT51030Medicare UPIN
NYP34831Medicare PIN