Basic Information
| Provider Information | |||||||||
| NPI: | 1649517624 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELGADO | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, PHARMD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 YARMOUTH LN | ||||||||
| Address2: | |||||||||
| City: | NESCONSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117671609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2397898989 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 75 N COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117772119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316861443 | ||||||||
| FaxNumber: | 6316867651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2013 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 061662 | NY | N | Pharmacy Service Providers | Pharmacist | 183500000X | PS42922 | FL | N | Pharmacy Service Providers | Pharmacist | 183500000X | 03135483 | OH | N | Pharmacy Service Providers | Pharmacist | 183500000X | 24153 | MD | N | Pharmacy Service Providers | Pharmacist | 390200000X | 1649517624 | NY | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.