Individual
DR. PHILIPPE VAILLANCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
712 MAIN ST, ISLIP, NY 11751-3620
(631) 666-3939
(631) 666-3994
Mailing address
712 MAIN ST, ISLIP, NY 11751-3620
(631) 666-3939
(631) 666-3994
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
139436
NY
208VP0000X
Pain Medicine Physician
139436
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00976572
—
NY
Enumeration date
02/21/2006
Last updated
06/09/2016
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