MEDICARE: JOSEPH J LACARRUBBA DDS

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	122300000X	Dentist	047278 1	NY

General Provider Information

NPI Number	:	1629113329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH J LACARRUBBA DDS

Provider Business Mailing Address
First Line	:	2500 NESCONSET HWY
Second Line	:	SUITE 11 A
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2553
Country	:	US
Telephone Number	:	631-751-7171
Fax Number	:	631-751-7530

Provider Business Practice Location Address
First Line	:	2500 NESCONSET HWY
Second Line	:	SUITE 11 A
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2553
Country	:	US
Telephone Number	:	631-751-7171
Fax Number	:	631-751-7530

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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