MEDICARE: DR. DAVID JAMES ZEGARELLI D.D.S.

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	028200-1	NY
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	028200-1	NY
3	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	028200-1	NY
4	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	028200-1	NY
5	207ZP0101X	Anatomic Pathology Physician	028200-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02Q131	OTHER	NY	EMPIRE BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346251170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JAMES ZEGARELLI D.D.S.

Provider Business Mailing Address
First Line	:	630 W 168TH ST
Second Line	:	PH 15W- 1562
City	:	NEW YORK
State	:	NY
Zip	:	10032-3725
Country	:	US
Telephone Number	:	212-305-4599
Fax Number	:	212-305-5958

Provider Business Practice Location Address
First Line	:	87 N BROADWAY
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-3231
Country	:	US
Telephone Number	:	914-631-9088
Fax Number	:

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	12/21/2007

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Directions to “ DR. DAVID JAMES ZEGARELLI D.D.S.” Practice Location

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