Provider Demographics
NPI:1942498068
Name:DOMINICK N PIACENTE PHYSICIAN PC
Entity Type:Organization
Organization Name:DOMINICK N PIACENTE PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:PIACENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-826-0753
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-0171
Mailing Address - Country:US
Mailing Address - Phone:914-826-0753
Mailing Address - Fax:914-346-5176
Practice Address - Street 1:140 LOCKWOOD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4915
Practice Address - Country:US
Practice Address - Phone:914-826-0753
Practice Address - Fax:914-346-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty