MEDICARE: DR. JAIME PHILIP D.D.S

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	122300000X	Dentist	0580311	NY

General Provider Information

NPI Number	:	1235552266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIME PHILIP D.D.S

Provider Business Mailing Address
First Line	:	80 GUY LOMBARDO AVE
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3715
Country	:	US
Telephone Number	:	516-546-6709
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 GUY LOMBARDO AVE
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3715
Country	:	US
Telephone Number	:	516-546-6709
Fax Number	:

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

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	08/03/2015

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