Provider Demographics
NPI:1972775674
Name:DERARIO, JOSEPH S (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:DERARIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 PARK AVE
Mailing Address - Street 2:41ST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10167-0002
Mailing Address - Country:US
Mailing Address - Phone:212-922-0820
Mailing Address - Fax:212-922-0833
Practice Address - Street 1:245 PARK AVE
Practice Address - Street 2:41ST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10167-0002
Practice Address - Country:US
Practice Address - Phone:212-922-0820
Practice Address - Fax:212-922-0833
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1009605001223G0001X
NY040609-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972775674OtherNPI