MEDICARE: ANDREW J RESTIVO 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	207P00000X	Emergency Medicine Physician	260475	NY

General Provider Information

NPI Number	:	1376840850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW J RESTIVO M.D.

Provider Business Mailing Address
First Line	:	4751 40TH ST
Second Line	:
City	:	LONG IS CITY
State	:	NY
Zip	:	11104-4052
Country	:	US
Telephone Number	:	347-724-7265
Fax Number	:

Provider Business Practice Location Address
First Line	:	4751 40TH ST
Second Line	:
City	:	LONG IS CITY
State	:	NY
Zip	:	11104-4052
Country	:	US
Telephone Number	:	347-724-7265
Fax Number	:

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

Provider Enumeration Date	:	02/18/2011
Last Update Date	:	02/18/2011

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