Provider Demographics
NPI:1902103864
Name:DIANE AND RAYMOND MAGLIULO, DO PC
Entity Type:Organization
Organization Name:DIANE AND RAYMOND MAGLIULO, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGLIULO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-969-0000
Mailing Address - Street 1:245 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8323
Mailing Address - Country:US
Mailing Address - Phone:631-969-0000
Mailing Address - Fax:631-969-1094
Practice Address - Street 1:245 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8323
Practice Address - Country:US
Practice Address - Phone:631-969-0000
Practice Address - Fax:631-969-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183975261QP2300X
NY183013261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100591Medicare PIN
F16831Medicare UPIN
NYG01027Medicare UPIN
NY18G032Medicare PIN