Healthcare Provider Details

I. General information

NPI: 1740971399
Provider Name (Legal Business Name): TOUCH STONE PAVILION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 SEGUINE AVENUE
STATEN ISLAND NY
10309
US

IV. Provider business mailing address

318 SEGUINE AVENUE
STATEN ISLAND NY
10309
US

V. Phone/Fax

Practice location:
  • Phone: 718-356-9222
  • Fax: 718-605-4729
Mailing address:
  • Phone: 718-356-9222
  • Fax: 718-605-4729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELO A. DIMAGGIO
Title or Position: OPERATOR/PRESIDENT
Credential: DC
Phone: 718-356-9222