MEDICARE: ORANGETOWN FAMILY PRACTICE

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	207Q00000X	Family Medicine Physician	167148-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CE2055	OTHER	NY	RAILROAD MEDICARE GROUP #

General Provider Information

NPI Number	:	1306884440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORANGETOWN FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	97 ROUTE 303
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-2514
Country	:	US
Telephone Number	:	845-359-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	97 ROUTE 303
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-2514
Country	:	US
Telephone Number	:	845-359-5005
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	VINCENT M IBELLI
Credential	:	MD
Telephone Number	:	845-359-5005

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/02/2009

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Directions to “ORANGETOWN FAMILY PRACTICE ” Practice Location

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