Provider Demographics
NPI:1790877603
Name:SQUILLANTE, NIEL J (MD)
Entity Type:Individual
Prefix:MR
First Name:NIEL
Middle Name:J
Last Name:SQUILLANTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12 SMITH FARM RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506-2030
Mailing Address - Country:US
Mailing Address - Phone:914-419-3554
Mailing Address - Fax:914-234-0230
Practice Address - Street 1:12 SMITH FARM RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NY
Practice Address - Zip Code:10506-2030
Practice Address - Country:US
Practice Address - Phone:914-419-3554
Practice Address - Fax:914-234-0230
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2022-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY104042207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02663885Medicaid
NY00180772Medicaid
NYB17553Medicare UPIN
NY653102Medicare PIN