MEDICARE: KITAJ HEADACHE CENTER LLC

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	2084N0400X	Neurology Physician	205773	NY

General Provider Information

NPI Number	:	1790876324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KITAJ HEADACHE CENTER LLC

Provider Business Mailing Address
First Line	:	2649 STRANG BLVD
Second Line	:	SUITE 208
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-2939
Country	:	US
Telephone Number	:	914-245-3962
Fax Number	:	914-254-3963

Provider Business Practice Location Address
First Line	:	2649 STRANG BLVD
Second Line	:	SUITE 208
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-2939
Country	:	US
Telephone Number	:	914-245-3962
Fax Number	:	914-254-3963

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. MADELEINE B KITAJ
Credential	:	M.D.
Telephone Number	:	203-262-8430

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	03/26/2008

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