Provider Demographics
NPI:1386717460
Name:FIORELLO, JANINE (NPP)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:FIORELLO
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2206
Mailing Address - Country:US
Mailing Address - Phone:516-586-4742
Mailing Address - Fax:516-586-4742
Practice Address - Street 1:405 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1651
Practice Address - Country:US
Practice Address - Phone:631-567-1626
Practice Address - Fax:631-567-1648
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400871-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF400871-1OtherLICENSE
112XJ04091OtherMEDICARE PROVIDER #