Provider Demographics
NPI:1497803126
Name:ABBATIELLO, VINCENT JEROME (DMD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JEROME
Last Name:ABBATIELLO
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 1:45 GLEN COVE ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1057
Mailing Address - Country:US
Mailing Address - Phone:516-484-4741
Mailing Address - Fax:516-484-6058
Practice Address - Street 1:45 GLEN COVE ROAD
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1057
Practice Address - Country:US
Practice Address - Phone:516-484-4741
Practice Address - Fax:516-484-6058
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028672-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics