MEDICARE: DR. GERARD JOSEPH IGEL 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	149545	NY

General Provider Information

NPI Number	:	1255499661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD JOSEPH IGEL M.D.

Provider Business Mailing Address
First Line	:	565 W END AVE
Second Line	:	APARTMENT 18D
City	:	NEW YORK
State	:	NY
Zip	:	10024-2705
Country	:	US
Telephone Number	:	212-769-0467
Fax Number	:	212-769-0484

Provider Business Practice Location Address
First Line	:	1613 TENBROECK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2007
Country	:	US
Telephone Number	:	718-828-9060
Fax Number	:	718-828-9845

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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