MEDICARE: LISA MARIE VALOW-PICARELLO 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	207Q00000X	Family Medicine Physician	204365	NY

General Provider Information

NPI Number	:	1215987862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE VALOW-PICARELLO M.D.

Provider Business Mailing Address
First Line	:	10 DILTZ RD
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-2720
Country	:	US
Telephone Number	:	845-362-4092
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 ROUTE 208
Second Line	:	SUITE 15
City	:	MONROE
State	:	NY
Zip	:	10950-1608
Country	:	US
Telephone Number	:	845-783-6699
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/08/2007

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