MEDICARE: MICHELE MARIE DISCO CGC

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1225461015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE MARIE DISCO CGC

Provider Business Mailing Address
First Line	:	225 COMMUNITY DR RM 110
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5506
Country	:	US
Telephone Number	:	516-918-4800
Fax Number	:	516-918-4839

Provider Business Practice Location Address
First Line	:	225 COMMUNITY DR
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5503
Country	:	US
Telephone Number	:	516-918-4800
Fax Number	:

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

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	12/04/2017

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