MEDICARE: MR. NIEL J SQUILLANTE M.D.

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	207WX0107X	Retina Specialist (Ophthalmology) Physician	104042	NY
2	207W00000X	Ophthalmology Physician	104042	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790877603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NIEL J SQUILLANTE M.D.

Provider Business Mailing Address
First Line	:	12 SMITH FARM RD
Second Line	:
City	:	BEDFORD
State	:	NY
Zip	:	10506-2030
Country	:	US
Telephone Number	:	914-419-3554
Fax Number	:	914-234-0230

Provider Business Practice Location Address
First Line	:	12 SMITH FARM RD
Second Line	:
City	:	BEDFORD
State	:	NY
Zip	:	10506-2030
Country	:	US
Telephone Number	:	914-419-3554
Fax Number	:	914-234-0230

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	10/24/2022

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