Healthcare Provider Details

I. General information

NPI: 1407002264
Provider Name (Legal Business Name): PASQUALE J. MALPESO DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 PARK AVE
NEW YORK NY
10065-7314
US

IV. Provider business mailing address

563 PARK AVE
NEW YORK NY
10065-7314
US

V. Phone/Fax

Practice location:
  • Phone: 212-838-0090
  • Fax: 212-935-1296
Mailing address:
  • Phone: 212-838-0090
  • Fax: 212-935-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNY

VIII. Authorized Official

Name: MRS. JEANETTE DIAZ
Title or Position: MEDICAL BILLER
Credential:
Phone: 212-838-0090