MEDICARE: MS. MARIA D MONTALBANO SCORZELLI P.A.

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	363A00000X	Physician Assistant	005693	NY

General Provider Information

NPI Number	:	1083660260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA D MONTALBANO SCORZELLI P.A.

Provider Business Mailing Address
First Line	:	519W JERICHO TPKE
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-2619
Country	:	US
Telephone Number	:	631-360-5900
Fax Number	:	631-360-9403

Provider Business Practice Location Address
First Line	:	465 BLUE POINT RD
Second Line	:
City	:	FARMINGVILLE
State	:	NY
Zip	:	11738-1839
Country	:	US
Telephone Number	:	631-732-5999
Fax Number	:

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/14/2015

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