Provider Demographics
NPI:1477559748
Name:PUGLIESE, MICHAEL T (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:PUGLIESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:655 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1314
Mailing Address - Country:US
Mailing Address - Phone:631-321-2100
Mailing Address - Fax:631-321-2246
Practice Address - Street 1:655 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1314
Practice Address - Country:US
Practice Address - Phone:631-321-2100
Practice Address - Fax:631-321-2246
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1413992080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2552217OtherOXFORD HEALTH PLAN
NY4248303OtherAETNA MANAGED CARE
NY7P4802OtherBLUE CROSS BLUE SHIELD
NYAA48406OtherMDNY
NY49083OtherVYTRA HEALTHCARE
NY040426011085OtherFIDELIS
NY2399869OtherGHI
NY359817OtherUNITEDHEALTHCARE
NY01511848Medicaid
NY0340942OtherCIGNA
NY33-00335OtherUHC CHILD HEALTH PLUS
NY6451745OtherAETNA/US HEALTHCARE
NY2399869OtherGHI
NY6451745OtherAETNA/US HEALTHCARE