Provider Demographics
NPI:1912742297
Name:TELESE, ATTILIO
Entity type:Individual
Prefix:
First Name:ATTILIO
Middle Name:
Last Name:TELESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TARA LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2337
Mailing Address - Country:US
Mailing Address - Phone:516-263-1635
Mailing Address - Fax:
Practice Address - Street 1:500 BI COUNTY BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3988
Practice Address - Country:US
Practice Address - Phone:631-473-4284
Practice Address - Fax:631-546-7493
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician