Provider Demographics
NPI:1053638387
Name:NUNZIATA, DREW A (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:A
Last Name:NUNZIATA
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 ROUTE 59
Mailing Address - Street 2:RAMAPO ORAL AND MAXILLOFACIAL SURGERY
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901
Mailing Address - Country:US
Mailing Address - Phone:845-357-2070
Mailing Address - Fax:845-357-2144
Practice Address - Street 1:84 ROUTE 59
Practice Address - Street 2:RAMAPO ORAL AND MAXILLOFACIAL SURGERY
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-357-2070
Practice Address - Fax:845-357-2144
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280315204E00000X
NY0586021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery