MEDICARE: DR. PASQUALE J MALPESO D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry	038 607	NY

General Provider Information

NPI Number	:	1073647772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PASQUALE J MALPESO D.M.D.

Provider Business Mailing Address
First Line	:	563 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-7314
Country	:	US
Telephone Number	:	212-838-0090
Fax Number	:	212-935-1296

Provider Business Practice Location Address
First Line	:	563 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-7314
Country	:	US
Telephone Number	:	212-838-0090
Fax Number	:	212-935-1296

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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