1457487928 NPI number — CHARLES D AZZARETTI DDS AND ELLEN G HOLLIDAY DDS

Table of content: (NPI 1457487928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457487928 NPI number — CHARLES D AZZARETTI DDS AND ELLEN G HOLLIDAY DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES D AZZARETTI DDS AND ELLEN G HOLLIDAY DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457487928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
439 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT KISCO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10549-3404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-666-3310
Provider Business Mailing Address Fax Number:
914-666-7924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
439 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT KISCO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10549-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-666-3310
Provider Business Practice Location Address Fax Number:
914-666-7924
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLIDAY
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
914-666-3310

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  36579 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 36012 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com