MEDICARE: NEURO CARE MEDICAL, P.C.

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	194198	NY

General Provider Information

NPI Number	:	1225251358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO CARE MEDICAL, P.C.

Provider Business Mailing Address
First Line	:	1513 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3994
Country	:	US
Telephone Number	:	718-332-7878
Fax Number	:	718-815-0005

Provider Business Practice Location Address
First Line	:	1163 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-2408
Country	:	US
Telephone Number	:	718-815-3529
Fax Number	:	718-815-0005

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RANGA C KRISHNA
Credential	:	MD
Telephone Number	:	718-815-3529

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/20/2007

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