| Doctor Name: | DR. JAMES PEZZOLLO |
| NPI Number: | 1184081960 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DMD |
| License Number: | |
| Business Practice Address: | 27005 76th Ave Lij Medical Center Department Of Dental Medicine New Hyde Park, NY - 110401402 |
| Business Phone Number: | 7184704120 |
| Business Fax Number: | |
| Mailing Address: | 27005 76th Ave, Lij Medical Center Department Of Dental Medicine NEW HYDE PARK |
| State: | NY |
| Postal Code: | 110401402 |
| Phone Number: | 7184704120 |
| Fax Number: | |
| NPI Enumeration Date: | 01/25/2016 |
| NPI Last Update Date: | 01/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |