Provider Demographics
NPI:1326579830
Name:POIDOMANI, PAUL (DO (MAY 2017 GRAD))
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:POIDOMANI
Suffix:
Gender:M
Credentials:DO (MAY 2017 GRAD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 HAMPTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-4973
Mailing Address - Country:US
Mailing Address - Phone:631-283-2100
Mailing Address - Fax:
Practice Address - Street 1:325 MEETING HOUSE LN STE 403
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-7000
Practice Address - Country:US
Practice Address - Phone:631-283-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-26
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310268207RH0002X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program