Provider Demographics
NPI:1962403519
Name:BACOTTI, JOSEPH L (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:BACOTTI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:825 E GATE BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2124
Mailing Address - Country:US
Mailing Address - Phone:516-804-5200
Mailing Address - Fax:516-240-6540
Practice Address - Street 1:330 OLD COUNTRY RD
Practice Address - Street 2:NUMBER 100
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-739-6600
Practice Address - Fax:516-739-6620
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2018-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY139827207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00436246Medicaid
B17388Medicare UPIN
NY64A451Medicare PIN