Individual
JUSTIN RIECE FAZZOLARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
200 W 57TH ST STE 804, NEW YORK, NY 10019-3217
(646) 895-9680
Mailing address
200 W 57TH ST STE 804, NEW YORK, NY 10019-3217
(646) 895-9680
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
065003
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
22DI03028700
NJ
Other
Enumeration date
03/25/2019
Last updated
08/19/2025
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