MEDICARE: CORAZON TOLENTINO MD

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	207R00000X	Internal Medicine Physician	111621	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

General Provider Information

NPI Number	:	1053347575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORAZON TOLENTINO MD

Provider Business Mailing Address
First Line	:	1000 ZECKENDORF BLVD
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-2133
Country	:	US
Telephone Number	:	516-542-6880
Fax Number	:	516-542-5556

Provider Business Practice Location Address
First Line	:	11218 SPRINGFIELD BLVD
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-2650
Country	:	US
Telephone Number	:	718-479-6600
Fax Number	:	718-217-3546

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

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	07/08/2007

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