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JUSTIN RIECE FAZZOLARI DMD, MD
NPI 1295296168
Dentist - Oral and Maxillofacial Surgery in New York, NY

Active since March 25, 2019Opted out of Medicare · through Oct 15, 2027
200 W 57TH ST STE 804, NEW YORK, NY 10019(646) 895-9680 Get Directions Write a Review

NPPES record last updated: August 19, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 4, 2025, Jun 9, 2025, Feb 22, 2023 (3 updates tracked since 2023).

About Justin Riece Fazzolari Dmd, Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JUSTIN RIECE FAZZOLARI DMD, MD (NPI 1295296168) is an individual oral and maxillofacial surgery provider in New York, New York, licensed in New York (065003) and active in the NPI registry since March 2019. He has opted out of Medicare through October 15, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1295296168
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameJUSTIN RIECE FAZZOLARICredential: DMD, MD
Location Address200 W 57TH ST STE 804New York, NY 10019-3217
Mailing Address200 W 57th St Ste 804New York, NY 10019-3217 · (646) 895-9680
Phone(646) 895-9680
Sole ProprietorNo
Enumeration DateMarch 25, 2019
Last NPPES UpdateAugust 19, 20253 updates tracked since enumeration
NPPES CertifiedAugust 19, 2025
✔ NPI 1295296168 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
Licenses✔ Licensed in NY · 065003✔ Licensed in NJ · 22DI03028700
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
200 W 57TH ST STE 804, New York, NY 10019
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Humana.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Justin Riece Fazzolari Dmd, Md has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 15, 2025 through October 15, 2027.

Opt-Out Effective DateOctober 15, 2025
Opt-Out In Effect ThroughOctober 15, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10019 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$102.04 typical visit price
range $65.69 – $198.19
Typical copayment $25.51 (range $16.42 – $49.54)
Most-billed visit code 99203
Established Patient
$81.44 typical visit price
range $21.20 – $160.66
Typical copayment $20.36 (range $5.30 – $40.16)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MISS KENDRA MARIE IRIZARRY PAGAN DMD
Dentist (Oral and Maxillofacial Surgery)
200 W 57TH ST STE 804
NEW YORK, NY 10019
New York County (646) 895-9680

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Justin Fazzolari's NPI number?

The NPI number for Justin Fazzolari is 1295296168. It was assigned to this individual provider in the NPPES registry on March 25, 2019.

Where is Justin Fazzolari located?

Justin Fazzolari practices at 200 W 57th St Ste 804, New York, NY 10019. The listed phone number is (646) 895-9680.

What is Justin Fazzolari's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Justin Fazzolari enrolled in Medicare?

No. Justin Fazzolari has opted out of Medicare through October 15, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Justin Fazzolari accept?

Health plans from Anthem Blue Cross and Blue Shield and Humana list Justin Fazzolari as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Justin Fazzolari was last updated on August 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.