Active NPI
Damian Forletti, M.D.
- Pediatrics Physician
- Port Jefferson Station, NY
National Provider Identifier
1689640690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 164113
- Practice address
- 815 Hallock Ave
Suite a
Port Jefferson Station, NY 11776-1244 - Phone
- (631) 331-7267
- NPI assigned
- Feb 28, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164113 | NY | MD | Pediatrics Physician |
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 164113 | NY | Primary |
Addresses
Primary practice location
815 Hallock Ave
Suite a
Port Jefferson Station, NY 11776-1244
Mailing address
PO Box 1559
Stony Brook, NY 11790
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 877643 | Other | NY | AETNA HMO ID |
| OC9245 | Other | NY | PHS / HEALTH NET |
| 164113 | Other | NY | HIP |
| CP103 | Other | NY | OXFORD ID |
| 2787 | Other | NY | VYTRA ID |
| 4061141 | Other | NY | AETNA NON-HMO ID |
| 2600579 | Other | NY | GHI PPO ID |
| 1807144003 | Other | NY | CIGNA ID |
| 5B780 | Other | NY | EMPIRE BC/BS |
| 000000059056 | Other | NY | GHI HMO ID |
| 01082773 | Medicaid | NY | |
| O85640 | Other | NY | UNITED HEALTH CARE |
NPI Registry JSON
{
"created_epoch": "1141084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505779200000",
"number": "1689640690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1559",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "11790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 HALLOCK AVE",
"address_2": "SUITE A",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117761244",
"telephone_number": "631-331-7267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORLETTI",
"first_name": "DAMIAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-28",
"last_updated": "2017-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "164113",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO ID",
"identifier": "877643",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHS / HEALTH NET",
"identifier": "OC9245",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIP",
"identifier": "164113",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD ID",
"identifier": "CP103",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VYTRA ID",
"identifier": "2787",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA NON-HMO ID",
"identifier": "4061141",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI PPO ID",
"identifier": "2600579",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA ID",
"identifier": "1807144003",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BC/BS",
"identifier": "5B780",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI HMO ID",
"identifier": "000000059056",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01082773",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "O85640",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson Station, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.