Provider Demographics
NPI:1306088505
Name:DAVID J. ZEGARELLI D.D.S. PLLC
Entity type:Organization
Organization Name:DAVID J. ZEGARELLI D.D.S. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CODING
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:845-634-6500
Mailing Address - Street 1:380 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:10510-2228
Mailing Address - Country:US
Mailing Address - Phone:914-923-0924
Mailing Address - Fax:
Practice Address - Street 1:200 CENTRAL PARK S
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1436
Practice Address - Country:US
Practice Address - Phone:914-923-0924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028000-11223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD96711Medicare PIN