MEDICARE: DR. JOHN C L'INSALATA M.D.

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	207X00000X	Orthopaedic Surgery Physician	186226	NY
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	186226	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	:	1518921055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN C L'INSALATA M.D.

Provider Business Mailing Address
First Line	:	9921 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-8347
Country	:	US
Telephone Number	:	718-238-5565
Fax Number	:	718-748-3526

Provider Business Practice Location Address
First Line	:	25 MANOR RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-2233
Country	:	US
Telephone Number	:	718-556-4700
Fax Number	:	718-556-4774

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	01/17/2013

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