Provider Demographics
NPI:1104096536
Name:FIORILLO, ANNETTE (DO,MS)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:FIORILLO
Suffix:
Gender:F
Credentials:DO,MS
Other - Prefix:DR
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:FIORILLO-QUINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO,MS
Mailing Address - Street 1:2266 WESTLAKE CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1416
Mailing Address - Country:US
Mailing Address - Phone:516-448-9180
Mailing Address - Fax:
Practice Address - Street 1:2940 LINCOLN AVE STE 200
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2195
Practice Address - Country:US
Practice Address - Phone:516-448-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243388207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3000047348Medicare NSC