MEDICARE: LADISLAO VACCARO

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	332BC3200X	Customized Equipment (DME)	424040190001	NY

General Provider Information

NPI Number	:	1447330618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADISLAO VACCARO

Provider Business Mailing Address
First Line	:	138 E POST RD
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-5202
Country	:	US
Telephone Number	:	914-723-3116
Fax Number	:	914-725-4143

Provider Business Practice Location Address
First Line	:	138 E POST RD
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-5202
Country	:	US
Telephone Number	:	914-723-3116
Fax Number	:	914-725-4143

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LADISLAO D VACCARO
Credential	:	PEDORTHIST
Telephone Number	:	914-723-3116

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	11/20/2008

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