Eugene P Pezzollo, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

035537 Issued in NY

Practice address

601 Franklin Ave
Garden City, NY 11530-5795

Phone

(516) 741-4415

NPI assigned

Sep 27, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rodney Rastegar DDS PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Garden City, NY
  • NPI 1508195975
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1063503670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 FRANKLIN AVE",
            "address_2": "ST 110",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115305795",
            "telephone_number": "516-741-4415",
            "fax_number": "516-741-4417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 FRANKLIN AVE",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115305795",
            "telephone_number": "516-741-4415"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23 Bond St",
            "address_purpose": "LOCATION",
            "city": "Great Neck",
            "state": "NY",
            "postal_code": "110212019",
            "country_code": "US",
            "telephone_number": "516-482-0329",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2035 Lakeville Rd",
            "address_purpose": "LOCATION",
            "city": "New Hyde Park",
            "state": "NY",
            "postal_code": "110401600",
            "country_code": "US",
            "telephone_number": "516-437-2666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEZZOLLO",
        "first_name": "EUGENE",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "035537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marisa Louise Peters, LMSW
• Kirsten E Petersen, MA, CCC-SLP, TSLD,BE
• Glenn Austin Petraitis, PTA
• Nicholas Petrini, PA-C
• Lorraine Elizabeth Petrizzo, MS.ED, BCBA
• James Pezzollo, DMD
• Donald Pfeifer, LCSW
• Melanie Rose Pfennig
• Philip R. Cassar M.D., P.C.
• Stephanie Philip, LMHC

• Oral and Maxillofacial Surgery (Dentist) in Garden City, NY
• Providers in Garden City, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.