Provider Demographics
NPI:1912020728
Name:SIDOTI, JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SIDOTI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1001
Mailing Address - Country:US
Mailing Address - Phone:516-983-6850
Mailing Address - Fax:516-942-7615
Practice Address - Street 1:444 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1001
Practice Address - Country:US
Practice Address - Phone:516-983-6850
Practice Address - Fax:516-942-7615
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist