MEDICARE: ERIC DEGAETANO DO

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	207R00000X	Internal Medicine Physician	OS025979	PA

General Provider Information

NPI Number	:	1316406127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC DEGAETANO DO

Provider Business Mailing Address
First Line	:	225 CORTELYOU AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-2420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 BERGEN ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2496
Country	:	US
Telephone Number	:	973-972-4300
Fax Number	:

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	06/08/2026

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