Provider Demographics
NPI:1457368292
Name:BELLET, NEIL LOUIS (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:LOUIS
Last Name:BELLET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BRENTWOOD RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6943
Mailing Address - Country:US
Mailing Address - Phone:631-665-0328
Mailing Address - Fax:631-665-0371
Practice Address - Street 1:53 BRENTWOOD RD
Practice Address - Street 2:SUITE D
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6943
Practice Address - Country:US
Practice Address - Phone:631-665-0328
Practice Address - Fax:631-665-0371
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12747310 1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1129OtherVYTRA
B13713Medicare UPIN
1129OtherVYTRA