MEDICARE: DR. REGINA M. ASARO D.O.

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	A1791961	NY
2	208100000X	Physical Medicine & Rehabilitation Physician	A1791961	NY

General Provider Information

NPI Number	:	1336135193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINA M. ASARO D.O.

Provider Business Mailing Address
First Line	:	6263 82ND PL
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-1904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6263 82ND PL
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-1904
Country	:	US
Telephone Number	:	718-446-7200
Fax Number	:

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	01/10/2008

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