Healthcare Provider Details

I. General information

NPI: 1922314376
Provider Name (Legal Business Name): JOSEPH J DENATALE PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 CENTRAL PARK AVE STE 208
SCARSDALE NY
10583-1034
US

IV. Provider business mailing address

PO BOX 1352
SCARSDALE NY
10583-9352
US

V. Phone/Fax

Practice location:
  • Phone: 914-965-6655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number183014
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number183014
License Number StateNY

VIII. Authorized Official

Name: JOSEPH J DENATALE
Title or Position: MD
Credential:
Phone: 914-965-6655