MEDICARE: STATEN ISLAND SMILES AT THE PAVILLION

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	1223G0001X	General Practice Dentistry	042434	NY

General Provider Information

NPI Number	:	1821228164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATEN ISLAND SMILES AT THE PAVILLION

Provider Business Mailing Address
First Line	:	1887 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3923
Country	:	US
Telephone Number	:	718-761-5600
Fax Number	:	718-761-7966

Provider Business Practice Location Address
First Line	:	1887 RICHMOND AVE
Second Line	:	SUITE 4
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3923
Country	:	US
Telephone Number	:	718-761-5600
Fax Number	:	718-761-7966

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JOSEPH T MORMINO
Credential	:	D.D.S.
Telephone Number	:	718-761-5600

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	07/21/2009

Similar Medicare Providers

1679774905 — DR. ABRAHAM S. BIEGELEISEN D.D.S., P.C.
Practice Location Address:

1887 RICHMOND AVE
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10314-3923

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Practice Fax:

1679762116 — MRS. BEATA GRAZYNA CONTRI M.S. CCC-A
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1093986044 — MS. HARRIET FRIEDMAN-WILSON MS
Practice Location Address:

1887 RICHMOND AVE , SUITE V
STATEN ISLAND, NY
10314-3923

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1023525078 — MISS CAROLINA CHRISTINE PADILLA
Practice Location Address:

1887 RICHMOND AVE STE 5
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1720570187 — A FRIENDLY FACE AKADEMY CORP.
Practice Location Address:

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1275025348 — A FRIENDLY FACE AKADEMY CORP.
Practice Location Address:

1887 RICHMOND AVE STE 5
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Practice Phone: 718-698-1300
Practice Fax: 917-677-8601

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