MEDICARE: DR. HAMAD CORNELL SKINNER D.D.S

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	122300000X	Dentist	048009	NY

General Provider Information

NPI Number	:	1063512788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAMAD CORNELL SKINNER D.D.S

Provider Business Mailing Address
First Line	:	3311 GILES PL
Second Line	:	APT. 6H
City	:	BRONX
State	:	NY
Zip	:	10463-4309
Country	:	US
Telephone Number	:	718-884-5835
Fax Number	:	718-884-5835

Provider Business Practice Location Address
First Line	:	651 W 168TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3703
Country	:	US
Telephone Number	:	212-740-1780
Fax Number	:	212-543-4507

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

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. HAMAD CORNELL SKINNER D.D.S” Practice Location

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