MEDICARE: TONIANN CONETTA M.S ECE

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	252Y00000X	Early Intervention Provider Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	171M00000X	OTHER	NY	SPECIALIST

General Provider Information

NPI Number	:	1568725356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONIANN CONETTA M.S ECE

Provider Business Mailing Address
First Line	:	2323 SEYMOUR AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5739
Country	:	US
Telephone Number	:	347-653-7404
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 SEYMOUR AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5739
Country	:	US
Telephone Number	:	347-653-7404
Fax Number	:

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

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	06/18/2012

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