MEDICARE: DR. LEILANI PALMA BESA-LORIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	143795	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073585923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEILANI PALMA BESA-LORIA M.D.

Provider Business Mailing Address
First Line	:	44 REGAL WALK
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1770
Country	:	US
Telephone Number	:	718-494-3981
Fax Number	:	718-698-9666

Provider Business Practice Location Address
First Line	:	11905 ROCKAWAY BLVD
Second Line	:
City	:	SOUTH OZONE PARK
State	:	NY
Zip	:	11420-2421
Country	:	US
Telephone Number	:	718-843-3003
Fax Number	:	718-843-3504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2006
Last Update Date	:	07/08/2007

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