Healthcare Provider Details

I. General information

NPI: 1922061274
Provider Name (Legal Business Name): STEPHEN ABBATICCHIO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 STATE ROUTE 79 N SUITE 7
MORGANVILLE NJ
07751-2078
US

IV. Provider business mailing address

64 WILLOWBROOK CT
STATEN ISLAND NY
10302-2402
US

V. Phone/Fax

Practice location:
  • Phone: 732-817-1100
  • Fax: 732-817-1102
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number022398
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: