Provider Demographics
NPI:1477595882
Name:COMPREHENSIVE OBSTETRICS & GYNECOLOGY OF LONG ISLAND PLLC
Entity type:Organization
Organization Name:COMPREHENSIVE OBSTETRICS & GYNECOLOGY OF LONG ISLAND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VULLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-321-4811
Mailing Address - Street 1:556 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4407
Mailing Address - Country:US
Mailing Address - Phone:631-321-4811
Mailing Address - Fax:631-321-4814
Practice Address - Street 1:556 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4407
Practice Address - Country:US
Practice Address - Phone:631-321-4811
Practice Address - Fax:631-321-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W85241Medicare PIN