MEDICARE: TIMOTHY FATATO LAC

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	171100000X	Acupuncturist	006178	NY

General Provider Information

NPI Number	:	1518434315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY FATATO LAC

Provider Business Mailing Address
First Line	:	364 SAINT MARKS AVE APT 5A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-3698
Country	:	US
Telephone Number	:	845-323-0881
Fax Number	:

Provider Business Practice Location Address
First Line	:	364 SAINT MARKS AVE APT 5A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-3698
Country	:	US
Telephone Number	:	845-323-0881
Fax Number	:

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

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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