Provider Demographics
NPI:1487737516
Name:MAGLIULO, RAYMOND ROCCO (DO)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ROCCO
Last Name:MAGLIULO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8323
Mailing Address - Country:US
Mailing Address - Phone:631-969-0000
Mailing Address - Fax:631-969-1094
Practice Address - Street 1:245 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8323
Practice Address - Country:US
Practice Address - Phone:631-969-0000
Practice Address - Fax:631-969-1094
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183013207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF16831Medicare UPIN
NY18G032Medicare ID - Type Unspecified