Justin Riece Fazzolari, DMD, MD is a medicare enrolled "Student In An Organized Health Care Education/training Program" provider in New York, New York. His current practice location is
622 W 168th St # 7-238, New York, New York. You can reach out to his office (for appointments etc.) via phone at
(908) 461-2508.
Justin Riece Fazzolari is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1295296168.
Healthcare Provider's Profile
Full Name | Justin Riece Fazzolari |
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Gender | Male |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 622 W 168th St # 7-238, New York, New York |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1295296168
- Provider Enumeration Date: 03/25/2019
- Last Update Date: 06/09/2025
Medicare PECOS Information:
- PECOS PAC ID: 1951639665
- Enrollment ID: I20190820000400
Medical Identifiers
Medical identifiers for Justin Riece Fazzolari such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1295296168 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
1223S0112X | Dentist - Oral And Maxillofacial Surgery | 22DI03028700 (New Jersey) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Justin Riece Fazzolari is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Justin Riece Fazzolari, DMD, MD 622 W 168th St # 7-238, New York, NY 10032-3720 Ph: (908) 461-2508 | Justin Riece Fazzolari, DMD, MD 622 W 168th St # 7-238, New York, NY 10032-3720 Ph: (908) 461-2508 |
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