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Organization
PARK 62 PERIO & PERIO-PROSTHESIS PC
Active
Organization
PARK 62 PERIO & PERIO-PROSTHESIS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PASQUALE MALPESO DMD (PRESIDENT)
(212) 838-0090
Entity
Organization
Contact information
Practice address
563 PARK AVE, NEW YORK, NY 10065-7379
(212) 838-0090
Mailing address
563 PARK AVE, NEW YORK, NY 10065-7379
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
440777
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
440777
THE JOINT COMMISSION
NY
Enumeration date
09/07/2016
Last updated
09/07/2016
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