MEDICARE: DR. ROBERT MICHAEL PELLEGRINO 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	1223G0001X	General Practice Dentistry	032408	NY

General Provider Information

NPI Number	:	1750377503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MICHAEL PELLEGRINO DDS

Provider Business Mailing Address
First Line	:	241 WESTMINSTER RD
Second Line	:
City	:	WEST HEMPSTEAD
State	:	NY
Zip	:	11552-1637
Country	:	US
Telephone Number	:	516-485-9145
Fax Number	:	516-485-9145

Provider Business Practice Location Address
First Line	:	241 WESTMINSTER RD
Second Line	:
City	:	WEST HEMPSTEAD
State	:	NY
Zip	:	11552-1637
Country	:	US
Telephone Number	:	516-485-9145
Fax Number	:	516-485-9145

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	02/12/2015

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