MEDICARE: DR. JUAN A CORTES D.O.

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	212652	NY

General Provider Information

NPI Number	:	1508957804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN A CORTES D.O.

Provider Business Mailing Address
First Line	:	PO BOX 09 374
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209
Country	:	US
Telephone Number	:	718-836-2199
Fax Number	:	718-836-3184

Provider Business Practice Location Address
First Line	:	124 BAY RIDGE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5109
Country	:	US
Telephone Number	:	718-836-2199
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/05/2008

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