Justin Riece Fazzolari, DMD, MD is a student in an organized health care education training program in New York, NY. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. Justin Riece Fazzolari, DMD, MD NPI is 1295296168. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
622 W 168TH ST # 7-238
NEW YORK, NY
ZIP 10032-720
Phone: (908) 461-2508
The NPI 1295296168 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).
The enumeration date for this NPI number is 3/25/2019 and was last updated on 2/22/2023.