Healthcare Provider Details

I. General information

NPI: 1831392919
Provider Name (Legal Business Name): THOMAS JOSEPH ZICARELLI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 MADISON AVE SUITE 1706
NEW YORK NY
10021-8404
US

IV. Provider business mailing address

654 MADISON AVE SUITE 1706
NEW YORK NY
10021-8404
US

V. Phone/Fax

Practice location:
  • Phone: 212-421-9565
  • Fax:
Mailing address:
  • Phone: 212-421-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number041219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: