MEDICARE: FRANK PETER DEGIACOMO PC

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	111N00000X	Chiropractor	3327	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00177779	OTHER	NY	MEDICARE PTAN

General Provider Information

NPI Number	:	1225211063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANK PETER DEGIACOMO PC

Provider Business Mailing Address
First Line	:	8114 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3804
Country	:	US
Telephone Number	:	718-238-5120
Fax Number	:	718-238-5129

Provider Business Practice Location Address
First Line	:	8114 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3804
Country	:	US
Telephone Number	:	718-238-5120
Fax Number	:	718-238-5129

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. MARIE E. DEGIACOMO
Credential	:	D.C.
Telephone Number	:	718-238-5120

Provider Enumeration Date	:	12/16/2007
Last Update Date	:	04/07/2008

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