Provider Demographics
NPI:1053594150
Name:JOSEPH PATRICK FEARON D.D.S., P.C.
Entity type:Organization
Organization Name:JOSEPH PATRICK FEARON D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:FEARON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-799-1199
Mailing Address - Street 1:608A W END AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1603
Mailing Address - Country:US
Mailing Address - Phone:212-799-1199
Mailing Address - Fax:
Practice Address - Street 1:608A W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1603
Practice Address - Country:US
Practice Address - Phone:212-799-1199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040719261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental