MEDICARE: SIENNA MEDICAL CARE PLLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1508290321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIENNA MEDICAL CARE PLLC

Provider Business Mailing Address
First Line	:	421 78TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 STILLWELL AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1028
Country	:	US
Telephone Number	:	718-221-5800
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	EUGENE GIBILARO
Credential	:	MD
Telephone Number	:	718-630-5409

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	08/28/2013

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