Provider Demographics
NPI:1477885473
Name:LETTIERI, DOMINICK M
Entity Type:Individual
Prefix:
First Name:DOMINICK
Middle Name:M
Last Name:LETTIERI
Suffix:
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 1:4914 NEW UTRECHT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3418
Mailing Address - Country:US
Mailing Address - Phone:718-633-4900
Mailing Address - Fax:718-435-0324
Practice Address - Street 1:4914 NEW UTRECHT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3418
Practice Address - Country:US
Practice Address - Phone:718-633-4900
Practice Address - Fax:718-435-0324
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist