Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 028200-1 | NY |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 028200-1 | NY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 028200-1 | NY |
NPI | 1346251170 |
---|---|
Provider Name | Dr. David James Zegarelli |
First Address | New York, NY 10032-3725 |
Second Address | Tarrytown, NY 10591-3231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 21/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0057843 | (05) | NJ |
02Q131 | EMPIRE BCBS (01) | NY |
U31293 | (02) | NY |