MEDICARE: KATHRYN PALLONETTI D.M.D

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223P0221X	Pediatric Dentistry	059401	NY

General Provider Information

NPI Number	:	1801281282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN PALLONETTI D.M.D

Provider Business Mailing Address
First Line	:	4864 ARTHUR KILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-2650
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	739 WOODROW RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-2221
Country	:	US
Telephone Number	:	718-356-5437
Fax Number	:

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

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	06/21/2023

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