MEDICARE: DR. ELDOSE CHERIAN GEORGE M.D

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	208000000X	Pediatrics Physician	244503	NY

General Provider Information

NPI Number	:	1114127990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELDOSE CHERIAN GEORGE M.D

Provider Business Mailing Address
First Line	:	6 CRICKET CT
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729-6809
Country	:	US
Telephone Number	:	631-940-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 MONTAUK HWY
Second Line	:
City	:	WEST ISLIP
State	:	NY
Zip	:	11795-4411
Country	:	US
Telephone Number	:	631-669-2900
Fax Number	:

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

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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