Provider Demographics
NPI:1821064049
Name:TAGER, LEW, DEGAETANO
Entity Type:Organization
Organization Name:TAGER, LEW, DEGAETANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGAETANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-356-1477
Mailing Address - Street 1:3930 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5100
Mailing Address - Country:US
Mailing Address - Phone:718-356-1477
Mailing Address - Fax:718-317-0220
Practice Address - Street 1:3930 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5100
Practice Address - Country:US
Practice Address - Phone:718-356-1477
Practice Address - Fax:718-317-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02688811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty