Provider Demographics
NPI:1922061274
Name:ABBATICCHIO, STEPHEN (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:ABBATICCHIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 WILLOWBROOK CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:242 STATE ROUTE 79 N
Practice Address - Street 2:SUITE 7
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-2078
Practice Address - Country:US
Practice Address - Phone:732-817-1100
Practice Address - Fax:732-817-1102
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0223981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice