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NPI Code Detail

MEDICARE: DR. JOSEPH J FERTUCCI DDS

MEDICARE: DR. JOSEPH J FERTUCCI DDS
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
1122300000XDentist047222NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1204895164 TAX IDOTHERNYADDITIONAL OFFICE LOCATIO
2113556225OTHERNYADDITIONAL OFC LOCATION
3134015321 - TAX IDOTHERNYADDITIONAL LOCATION
4161515469OTHERNYADDITIONAL OFFICE LOCATIO

General Provider Information

NPI Number : 1538257647
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPH J FERTUCCI DDS
Provider Business Mailing Address
First Line : 2649 STRANG BLVD
Second Line : SUITE 300
City : YORKTOWN HEIGHTS
State : NY
Zip : 10598-2939
Country : US
Telephone Number : 914-245-7977
Fax Number : 914-245-7976
Provider Business Practice Location Address
First Line : 2649 STRANG BLVD
Second Line : SUITE 300
City : YORKTOWN HEIGHTS
State : NY
Zip : 10598-2939
Country : US
Telephone Number : 914-245-7977
Fax Number : 914-245-7976
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 06/19/2008

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Directions to “ DR. JOSEPH J FERTUCCI DDS” Practice Location

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