Provider Demographics
NPI:1285687095
Name:DELLISANTI, JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:DELLISANTI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GREGORY CT
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-5400
Mailing Address - Country:US
Mailing Address - Phone:631-667-2484
Mailing Address - Fax:631-667-8887
Practice Address - Street 1:54 DEER SHORE SQ
Practice Address - Street 2:
Practice Address - City:N BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1207
Practice Address - Country:US
Practice Address - Phone:631-667-2484
Practice Address - Fax:631-667-8887
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00461629Medicaid
NY0256050001Medicare ID - Type Unspecified