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General NPI Number Information
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NPI Number | 1477738953
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Entity Type | Organization
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Legal Business Name | JOHN W. DECORATO, M.D., P.C.
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 2777 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-4660
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Country | US
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Telephone | 718-987-0300
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Fax | 718-987-0305
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Provider Business Mailing Address
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Address Line | 2777 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-4660
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Country | US
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Telephone | 718-987-0300
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Fax | 718-987-0305
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN WILLIAM DECORATO
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Credential | M.D.
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Telephone | 718-987-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 167823
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License Number State | NY
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