MEDICARE: MR. NICHOLAS DELLORUSSO

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	183500000X	Pharmacist	037040	NY

General Provider Information

NPI Number	:	1932316353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS DELLORUSSO

Provider Business Mailing Address
First Line	:	5915 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4129
Country	:	US
Telephone Number	:	718-209-2222
Fax Number	:	718-209-9489

Provider Business Practice Location Address
First Line	:	5915 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4129
Country	:	US
Telephone Number	:	718-209-2222
Fax Number	:	718-209-9489

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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