Louis Tony Pannullo, DDS, M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

045189 Issued in NY

Practice address

397 Willis Ave
Williston Park, NY 11596-2208

Phone

(516) 294-1780

Fax

(516) 294-0748

NPI assigned

Oct 13, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

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    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1437249281",
    "addresses": [
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            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "397 WILLIS AVE",
            "city": "WILLISTON PARK",
            "state": "NY",
            "postal_code": "115962208",
            "telephone_number": "516-294-1780",
            "fax_number": "516-294-0748"
        },
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            "address_purpose": "LOCATION",
            "address_type": "DOM",
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            "city": "WILLISTON PARK",
            "state": "NY",
            "postal_code": "115962208",
            "telephone_number": "516-294-1780",
            "fax_number": "516-294-0748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANNULLO",
        "first_name": "LOUIS",
        "middle_name": "TONY",
        "credential": "DDS, M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "045189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "17411 Horace Harding Expy",
            "city": "Fresh Meadows",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113651527",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ltp9002@direct.nyp.org",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Address",
            "address_1": "17411 Horace Harding Expy",
            "city": "Fresh Meadows",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113651527",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "17411 Horace Harding Expy",
            "city": "Fresh Meadows",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113651527",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ny Therapeutic Specialists, Inc
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• Robert L. Paltzik, MD
• Melinda Pan
• Joseph L Pando, PH.D.
• Joseph Anthony Parisi, DDS
• Kristen Marie Parisi, DDS
• Elizabeth Fedalis Patton, RN BSN
• Daniela Perdomo
• Marta Virginia Perez-Lerouzic, RPH

• Periodontics in Williston Park, NY
• Providers in Williston Park, NY by specialty
• Periodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.