MEDICARE: MS. DIANA PALAZZO-GENTILE PA

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	003015-1	NY

General Provider Information

NPI Number	:	1225074958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANA PALAZZO-GENTILE PA

Provider Business Mailing Address
First Line	:	1 FOUNTAIN LN
Second Line	:
City	:	SCARSDALE
State	:	NY
Zip	:	10583-4654
Country	:	US
Telephone Number	:	718-960-6697
Fax Number	:	718-960-9089

Provider Business Practice Location Address
First Line	:	4487 3RD AVE
Second Line	:	ST. BARNABAS HOSPTIAL CLINIC 4TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10457-1526
Country	:	US
Telephone Number	:	718-960-6697
Fax Number	:	718-960-9089

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	01/03/2018

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