Provider Demographics
NPI:1174514483
Name:DAL PIZZOL, PETER FRANCIS (DMD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:FRANCIS
Last Name:DAL PIZZOL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6405
Mailing Address - Country:US
Mailing Address - Phone:201-224-8250
Mailing Address - Fax:
Practice Address - Street 1:1034 SAINT NICHOLAS AVE
Practice Address - Street 2:162 DENTAL PRACTICE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5242
Practice Address - Country:US
Practice Address - Phone:212-568-1222
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01392685Medicaid