MEDICARE: DR. NELSON SOCORRO MENEZES 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	2086S0129X	Vascular Surgery Physician	194948	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20-8604768	OTHER	NY	EMPLOYER IDENTIFICATION N
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255425948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELSON SOCORRO MENEZES M.D.

Provider Business Mailing Address
First Line	:	75 88TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209
Country	:	US
Telephone Number	:	718-238-2249
Fax Number	:	718-250-8460

Provider Business Practice Location Address
First Line	:	186 JORALEMON ST
Second Line	:	SUITE 1002
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4356
Country	:	US
Telephone Number	:	718-625-4100
Fax Number	:	718-625-4900

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/18/2012

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