Provider Demographics
NPI:1568676203
Name:SOLLECITO, JOSEPH BERNARD SR
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BERNARD
Last Name:SOLLECITO
Suffix:SR
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 1:8009 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-748-0513
Mailing Address - Fax:718-748-0822
Practice Address - Street 1:8009 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:718-748-0513
Practice Address - Fax:718-748-0822
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050061156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC747510Medicare PIN
NY0214630001Medicare NSC