Provider Demographics
NPI:1619045333
Name:DESALVO & SHYONG PC
Entity Type:Organization
Organization Name:DESALVO & SHYONG PC
Other - Org Name:DESALVO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:GINA
Authorized Official - Last Name:DESALVO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-224-3232
Mailing Address - Street 1:264 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024
Mailing Address - Country:US
Mailing Address - Phone:201-224-3232
Mailing Address - Fax:201-224-6030
Practice Address - Street 1:264 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024
Practice Address - Country:US
Practice Address - Phone:201-224-3232
Practice Address - Fax:201-224-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI017994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty