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General NPI Number Information
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NPI Number | 1699185991
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Entity Type | Individual
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Provider Name | JOSEPH MICHAEL MEROLA D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 6795 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10309-3819
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Country | US
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Telephone | 718-967-2412
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Fax | 718-554-4515
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Provider Business Mailing Address
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Address Line | 304 S GREENLEAF AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-2922
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Country | US
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Telephone | 466-778-1436
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Fax | 718-554-4515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 058625
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License Number State | NY
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