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General NPI Number Information
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NPI Number | 1821064049
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Entity Type | Organization
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Legal Business Name | TAGER, LEW, DEGAETANO
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 3930 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-5100
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Country | US
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Telephone | 718-356-1477
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Fax | 718-317-0220
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Provider Business Mailing Address
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Address Line | 3930 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-5100
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Country | US
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Telephone | 718-356-1477
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Fax | 718-317-0220
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Authorized Official
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Title or Position | DENTIST
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Name | MR. FRANK DEGAETANO
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Credential | DDS
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Telephone | 718-356-1477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0268881
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License Number State | NY
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