MEDICARE: CHRISTINE D'AMBROSIO-MAZZOCCHI

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	171W00000X	Contractor	537689	NY

General Provider Information

NPI Number	:	1497018386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE D'AMBROSIO-MAZZOCCHI

Provider Business Mailing Address
First Line	:	2013 W 11TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3540
Country	:	US
Telephone Number	:	917-613-7316
Fax Number	:

Provider Business Practice Location Address
First Line	:	2013 W 11TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3540
Country	:	US
Telephone Number	:	917-613-7316
Fax Number	:

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

Provider Enumeration Date	:	06/17/2012
Last Update Date	:	06/17/2012

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