| Jack Miceli Dds Pc | |
|
255 Mason Ave. Staten Island NY 10305-3416 | |
| (718) 987-6543 | |
| (718) 987-6542 |
| Full Name | Jack Miceli Dds Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 255 Mason Ave., Staten Island, New York |
| Authorized Official Name and Position | Jack Miceli (PRESIDENT) |
| Authorized Official Contact | 7189876543 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack Miceli Dds Pc 255 Mason Ave. Staten Island NY 10305-3416 Ph: (718) 987-6543 | Jack Miceli Dds Pc 255 Mason Ave. Staten Island NY 10305-3416 Ph: (718) 987-6543 |
| NPI Number | 1932266566 |
|---|---|
| Provider Enumeration Date | 01/02/2007 |
| Last Update Date | 02/23/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932266566 | NPI | - | NPPES |
| 02353280 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 39067 (New York) | Primary |
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