MEDICARE: MR. GERALD GENNARO DIMASO MD

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	207R00000X	Internal Medicine Physician	170623	NY
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	170623	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	:	1477526531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD GENNARO DIMASO MD

Provider Business Mailing Address
First Line	:	39 DORA LN
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1672
Country	:	US
Telephone Number	:	732-888-1975
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 SEGUINE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3723
Country	:	US
Telephone Number	:	718-356-6500
Fax Number	:	718-356-0348

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	01/18/2011

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