Provider Demographics
NPI:1740971399
Name:TOUCH STONE PAVILION, INC.
Entity type:Organization
Organization Name:TOUCH STONE PAVILION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIMAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-356-9222
Mailing Address - Street 1:318 SEGUINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309
Mailing Address - Country:US
Mailing Address - Phone:718-356-9222
Mailing Address - Fax:718-605-4729
Practice Address - Street 1:318 SEGUINE AVENUE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309
Practice Address - Country:US
Practice Address - Phone:718-356-9222
Practice Address - Fax:718-605-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty