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Organization
HOSPITAL
Active
Organization
HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTINE PAULA IPPOLITO-FATA D.D.S. (DENTIST)
(718) 329-1000
Entity
Organization
Contact information
Practice address
2466 ARTHUR AVE, BRONX, NY 10458-6004
(718) 329-1000
Mailing address
2466 ARTHUR AVE, BRONX, NY 10458-6004
(718) 329-1000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
043215
NY
282N00000X
General Acute Care Hospital
Primary
043215
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02259254
—
NY
01
—
043215
NEW YORK STATE EDUCATION DEPARTMENT LICENSE NUMBER
NY
Enumeration date
10/06/2015
Last updated
10/28/2015
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