Provider Demographics
NPI:1811074156
Name:DAPHNE GLEIT -CADURI MD, PC
Entity type:Organization
Organization Name:DAPHNE GLEIT -CADURI MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEIT-CADURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-499-4700
Mailing Address - Street 1:6268 JERICHO TPKE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2810
Mailing Address - Country:US
Mailing Address - Phone:631-499-4700
Mailing Address - Fax:631-499-8285
Practice Address - Street 1:6268 JERICHO TPKE
Practice Address - Street 2:SUITE 11
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2810
Practice Address - Country:US
Practice Address - Phone:631-499-4700
Practice Address - Fax:631-499-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1887232080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF97651Medicare UPIN