Healthcare Provider Details

I. General information

NPI: 1053307280
Provider Name (Legal Business Name): THOMAS JOHN PIZZOLO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 DUTCH HILL RD
ORANGEBURG NY
10962-2159
US

IV. Provider business mailing address

200 OTTOWA LN
FRANKLIN LAKES NJ
07417-2136
US

V. Phone/Fax

Practice location:
  • Phone: 845-359-8424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number040553
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: