Provider Demographics
NPI:1275964470
Name:ANNETTE FIORILLO, DO P.C.
Entity Type:Organization
Organization Name:ANNETTE FIORILLO, DO P.C.
Other - Org Name:LONG ISLAND ALLERGIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:FIORILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PC
Authorized Official - Phone:516-307-9140
Mailing Address - Street 1:2940 LINCOLN AVE
Mailing Address - Street 2:#200
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572
Mailing Address - Country:US
Mailing Address - Phone:516-307-9140
Mailing Address - Fax:516-706-6770
Practice Address - Street 1:2940 LINCOLN AVE
Practice Address - Street 2:#200
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2195
Practice Address - Country:US
Practice Address - Phone:516-307-9140
Practice Address - Fax:516-706-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243388207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03162392Medicaid
NY03162392Medicaid