Provider Demographics
NPI:1952571572
Name:JOHN FIORDALISI MD PLLC
Entity Type:Organization
Organization Name:JOHN FIORDALISI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIORDALISI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-406-5404
Mailing Address - Street 1:35 HAMPTON BAYS DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-3007
Mailing Address - Country:US
Mailing Address - Phone:646-406-5404
Mailing Address - Fax:718-320-7225
Practice Address - Street 1:166 E 88TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2255
Practice Address - Country:US
Practice Address - Phone:646-406-5404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169238207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
299T01OtherBC/BS
299T01OtherBC/BS