MEDICARE: DIGNICARE MEDICAL PLLC

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	1724301	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05762	OTHER	NY	GHI MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144361163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGNICARE MEDICAL PLLC

Provider Business Mailing Address
First Line	:	2060 E 61ST ST
Second Line	:	APT 1
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5908
Country	:	US
Telephone Number	:	347-254-6462
Fax Number	:	718-306-5238

Provider Business Practice Location Address
First Line	:	2060 E 61ST ST
Second Line	:	APT 1
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5908
Country	:	US
Telephone Number	:	347-254-6462
Fax Number	:	718-306-5238

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	DR. STEPHANIE DEJESUS
Credential	:	M.D.
Telephone Number	:	347-254-6462

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	08/01/2010

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Directions to “DIGNICARE MEDICAL PLLC ” Practice Location

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