Individual
DR. JOSEPH J FERTUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
047222
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113556225
ADDITIONAL OFC LOCATION
NY
01
—
134015321 - TAX ID
ADDITIONAL LOCATION
NY
01
—
161515469
ADDITIONAL OFFICE LOCATIO
NY
01
—
204895164 TAX ID
ADDITIONAL OFFICE LOCATIO
NY
Enumeration date
10/11/2006
Last updated
06/19/2008
Update your record
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