Provider Demographics
NPI:1013084763
Name:PUGLISSI, DINA MARIE (RPAC)
Entity Type:Individual
Prefix:MRS
First Name:DINA
Middle Name:MARIE
Last Name:PUGLISSI
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 PHIPPS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1403
Mailing Address - Country:US
Mailing Address - Phone:516-593-2733
Mailing Address - Fax:
Practice Address - Street 1:54 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3909
Practice Address - Country:US
Practice Address - Phone:516-488-1313
Practice Address - Fax:516-488-3449
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6403-1174400000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical