MEDICARE: DR. PETER JAMES PELLITTIERI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	042881	NY

General Provider Information

NPI Number	:	1134247067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER JAMES PELLITTIERI DMD

Provider Business Mailing Address
First Line	:	1140 CROSSPOINTE LN
Second Line	:	SUITE 1
City	:	WEBSTER
State	:	NY
Zip	:	14580-2988
Country	:	US
Telephone Number	:	585-872-0500
Fax Number	:	585-872-0501

Provider Business Practice Location Address
First Line	:	1140 CROSSPOINTE LN STE 1
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2988
Country	:	US
Telephone Number	:	585-872-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	01/28/2019

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