MEDICARE: ALPHONSE AVERSA 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	137745	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110146216	OTHER	NY	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0667910001	OTHER	NY	DME

General Provider Information

NPI Number	:	1053361378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALPHONSE AVERSA MD

Provider Business Mailing Address
First Line	:	110 S BEDFORD RD
Second Line	:	CAREMOUNT MEDICAL PC
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-3446
Country	:	US
Telephone Number	:	914-241-1050
Fax Number	:	914-242-1516

Provider Business Practice Location Address
First Line	:	90 S BEDFORD RD
Second Line	:	CARE MOUNT MEDICAL RD
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-3412
Country	:	US
Telephone Number	:	914-241-1050
Fax Number	:	914-242-1516

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	11/11/2016

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