Individual
DR. JASON ROBERT DI BLASI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
690 BROADWAY, SUITE 1, MASSAPEQUA, NY 11758
(516) 795-5769
(516) 795-8872
Mailing address
1 GARFIELD AVENUE, FARMINGDALE, NY 11735
(516) 385-5150
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
053299
NY
Other
Enumeration date
11/22/2006
Last updated
07/08/2007
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