Healthcare Provider Details

I. General information

NPI: 1518953280
Provider Name (Legal Business Name): VINCENT J FRAZZETTO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2096 VICTORY BLVD
STATEN ISLAND NY
10314-6604
US

IV. Provider business mailing address

2096 VICTORY BLVD
STATEN ISLAND NY
10314-6604
US

V. Phone/Fax

Practice location:
  • Phone: 718-494-1300
  • Fax: 718-370-7886
Mailing address:
  • Phone: 718-494-1300
  • Fax: 718-370-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number033636
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: