MEDICARE: CAMBRIA HEIGHTS MEDICAL CARE 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1437487386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMBRIA HEIGHTS MEDICAL CARE PC

Provider Business Mailing Address
First Line	:	21916 LINDEN BLVD
Second Line	:
City	:	CAMBRIA HTS
State	:	NY
Zip	:	11411
Country	:	US
Telephone Number	:	631-898-3137
Fax Number	:

Provider Business Practice Location Address
First Line	:	21916 LINDEN BLVD
Second Line	:
City	:	CAMBRIA HTS
State	:	NY
Zip	:	11411-1619
Country	:	US
Telephone Number	:	631-898-3137
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. IVAN D BARAGUE
Credential	:
Telephone Number	:	631-898-3137

Provider Enumeration Date	:	12/03/2009
Last Update Date	:	12/03/2009

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