MEDICARE: MARGARET STATILE NP

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	363L00000X	Nurse Practitioner	F331543-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396807442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET STATILE NP

Provider Business Mailing Address
First Line	:	165 MAIN ST
Second Line	:	OPEN DOOR FAMILY MEDICAL CENTERS, INC.
City	:	OSSINING
State	:	NY
Zip	:	10562-4702
Country	:	US
Telephone Number	:	914-941-1263
Fax Number	:	914-941-0993

Provider Business Practice Location Address
First Line	:	5 GRACE CHURCH ST
Second Line	:	OPEN DOOR FAMILY MEDICAL CENTERS, INC.
City	:	PORT CHESTER
State	:	NY
Zip	:	10573-4911
Country	:	US
Telephone Number	:	914-937-8899
Fax Number	:

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	12/07/2011

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