MEDICARE: ENDO ASSOCIATES OF STATEN ISLAND, 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1518107283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDO ASSOCIATES OF STATEN ISLAND, PLLC

Provider Business Mailing Address
First Line	:	360 EDISON ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3041
Country	:	US
Telephone Number	:	718-351-6389
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 EDISON ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3041
Country	:	US
Telephone Number	:	718-351-6389
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL MEGNA
Credential	:
Telephone Number	:	718-351-6377

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	02/20/2009

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