Provider Demographics
NPI:1760468847
Name:FIUMANO, SANTO J (DO)
Entity Type:Individual
Prefix:DR
First Name:SANTO
Middle Name:J
Last Name:FIUMANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 SOUTH WELLWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-226-8600
Mailing Address - Fax:631-957-7858
Practice Address - Street 1:502 SOUTH WELLWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-226-8600
Practice Address - Fax:631-957-7858
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01782172Medicaid
G54214Medicare UPIN
NY01782172Medicaid