1477642635 NPI number — THOMAS J BILLOTTI PHD

Table of content: THOMAS J BILLOTTI PHD (NPI 1477642635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477642635 NPI number — THOMAS J BILLOTTI PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BILLOTTI
Provider First Name:
THOMAS
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477642635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 H SPRINGMEDOW DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLBROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-360-3616
Provider Business Mailing Address Fax Number:
631-360-3616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 GILBERT AVE
Provider Second Line Business Practice Location Address:
SUITE 102B
Provider Business Practice Location Address City Name:
SMITHTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-360-3616
Provider Business Practice Location Address Fax Number:
631-360-3616
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  0081251 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0059283 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: AH00118 . This is a "MDNY" identifier . This identifiers is of the category "OTHER".




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