Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JACK ITALIANO III, DO
ActiveDR. JACK ITALIANO III, DO is a Sports Medicine healthcare provider located in NEW HYDE PARK, New York. NPI 1629606124 is currently active in the NPPES registry. Verify at CMS.
Sports Medicine · NEW HYDE PARK, NY
Registration Details
- NPI Number
- 1629606124
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Mar 30, 2020 (6.4084743876232 yrs)
- Last Updated
- Apr 2, 2025
- Licenses
-
327932 (NY)327932 (NY)
Practice Information
- Address
-
1999 MARCUS AVE STE 202NEW HYDE PARK, NY, 110421021Browse NY providers · Browse ZIP 11042
- Phone
- 5164678600
- Fax
- 6467549820
- Primary Specialty
-
Sports Medicine
207QS0010X
- Additional Specialty
- Sports Medicine
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.