Basic Information
| Provider Information | |||||||||
| NPI: | 1619232741 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DI BELLA | ||||||||
| FirstName: | BRITTNEY | ||||||||
| MiddleName: | DIANE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BORY | ||||||||
| OtherFirstName: | BRITTNEY | ||||||||
| OtherMiddleName: | DIANE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 350 MOTOR PKWY | ||||||||
| Address2: | SUITE #309 | ||||||||
| City: | HAUPPAUGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117885101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315147600 | ||||||||
| FaxNumber: | 6318131472 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HEALTHY WAY | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115721551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166324751 | ||||||||
| FaxNumber: | 5163362941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2012 | ||||||||
| LastUpdateDate: | 02/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 383585-1 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.