Provider Demographics
NPI:1407035082
Name:IOVINELLA, ARNOLD NICHOLAS JR
Entity Type:Individual
Prefix:MR
First Name:ARNOLD
Middle Name:NICHOLAS
Last Name:IOVINELLA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2713
Mailing Address - Country:US
Mailing Address - Phone:845-229-7650
Mailing Address - Fax:
Practice Address - Street 1:1572 ROUTE 9
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-2845
Practice Address - Country:US
Practice Address - Phone:845-298-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036316-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY036316-1Medicaid