Provider Demographics
NPI:1255328274
Name:LOIODICE, LOUIS F (DO)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:F
Last Name:LOIODICE
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 1:69 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8313
Mailing Address - Country:US
Mailing Address - Phone:631-969-4590
Mailing Address - Fax:631-665-3928
Practice Address - Street 1:69 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8313
Practice Address - Country:US
Practice Address - Phone:631-969-4590
Practice Address - Fax:631-665-3928
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01497474Medicaid
NY01559806Medicaid
NY01497474Medicaid
NY01559806Medicaid