Provider Demographics
NPI:1932298940
Name:ANDREW A. PASSARIELLO D.D.S. P.C.
Entity Type:Organization
Organization Name:ANDREW A. PASSARIELLO D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PASSARIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-979-0993
Mailing Address - Street 1:2627-C-HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4339
Mailing Address - Country:US
Mailing Address - Phone:718-979-0993
Mailing Address - Fax:718-979-4969
Practice Address - Street 1:2627-C-HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4339
Practice Address - Country:US
Practice Address - Phone:718-979-0993
Practice Address - Fax:718-979-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0279111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty