Provider Demographics
NPI:1548231913
Name:NIEL J SQUILLANTE MDPC
Entity Type:Organization
Organization Name:NIEL J SQUILLANTE MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES MED SERVICE CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:NIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SQUILLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-759-5559
Mailing Address - Street 1:140 E 80TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0306
Mailing Address - Country:US
Mailing Address - Phone:212-759-5559
Mailing Address - Fax:212-750-7634
Practice Address - Street 1:140 E 80TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0306
Practice Address - Country:US
Practice Address - Phone:212-759-5559
Practice Address - Fax:212-750-7634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104042207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B17553Medicare UPIN
NY653102Medicare PIN
NY653101Medicare PIN