Healthcare Provider Details

I. General information

NPI: 1346730611
Provider Name (Legal Business Name): PAUL JOHN ADDAMO JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST STE 2A8
BRONX NY
10451-5589
US

IV. Provider business mailing address

98 VALLEY RD
LEVITTOWN NY
11756-2928
US

V. Phone/Fax

Practice location:
  • Phone: 516-382-0388
  • Fax: 929-310-7940
Mailing address:
  • Phone: 516-382-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40150
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number341455-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number40150
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number062507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: