Provider Demographics
NPI:1730468034
Name:DAGOSTINO, SAVINO
Entity Type:Individual
Prefix:MR
First Name:SAVINO
Middle Name:
Last Name:DAGOSTINO
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 1:1402 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3408
Mailing Address - Country:US
Mailing Address - Phone:718-331-1010
Mailing Address - Fax:718-331-1095
Practice Address - Street 1:1402 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3408
Practice Address - Country:US
Practice Address - Phone:718-331-1010
Practice Address - Fax:718-331-1095
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5126156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician