Provider Demographics
NPI:1598327173
Name:ZIRILLI, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:ZIRILLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:BERKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 1ST AVE APT 7H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4941
Mailing Address - Country:US
Mailing Address - Phone:561-445-8428
Mailing Address - Fax:
Practice Address - Street 1:497 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-2333
Practice Address - Country:US
Practice Address - Phone:203-735-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0613591223G0001X
CT133401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice