Provider Demographics
NPI:1073647772
Name:MALPESO, PASQUALE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:PASQUALE
Middle Name:J
Last Name:MALPESO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7314
Mailing Address - Country:US
Mailing Address - Phone:212-838-0090
Mailing Address - Fax:212-935-1296
Practice Address - Street 1:563 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7314
Practice Address - Country:US
Practice Address - Phone:212-838-0090
Practice Address - Fax:212-935-1296
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038 6071223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD9F441Medicare ID - Type Unspecified
NYU29688Medicare UPIN