MEDICARE: MR. GARY GERARD MAIDA P.A.

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	363AM0700X	Medical Physician Assistant	001167	NY

General Provider Information

NPI Number	:	1487629242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY GERARD MAIDA P.A.

Provider Business Mailing Address
First Line	:	414 SAINT GEORGE RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-1524
Country	:	US
Telephone Number	:	718-967-6200
Fax Number	:	718-967-6314

Provider Business Practice Location Address
First Line	:	4982 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-6399
Country	:	US
Telephone Number	:	718-967-6200
Fax Number	:	718-967-6314

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/08/2007

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