Healthcare Provider Details

I. General information

NPI: 1346251170
Provider Name (Legal Business Name): DAVID JAMES ZEGARELLI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 N BROADWAY
TARRYTOWN NY
10591-3231
US

IV. Provider business mailing address

630 W 168TH ST PH 15W- 1562
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 914-631-9088
  • Fax:
Mailing address:
  • Phone: 212-305-4599
  • Fax: 212-305-5958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number028200-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number028200-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number028200-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number028200-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number028200-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: