MEDICARE: DR. ARACELI R DANTES 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	174400000X	Specialist	145403	NY

General Provider Information

NPI Number	:	1164517637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARACELI R DANTES M.D.

Provider Business Mailing Address
First Line	:	23 VIKING DR.
Second Line	:
City	:	WEST ISLIP
State	:	NY
Zip	:	11795
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 WEST MONTAUK HWY
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702
Country	:	US
Telephone Number	:	631-661-0545
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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