MEDICARE: DR. ANTHONY S DESANO DC

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	111N00000X	Chiropractor	X006997	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5802282	OTHER	NY	GHI
2	P2100896	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1548259021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY S DESANO DC

Provider Business Mailing Address
First Line	:	8416 JAMAICA AVE
Second Line	:
City	:	WOODHAVEN
State	:	NY
Zip	:	11421-1920
Country	:	US
Telephone Number	:	718-296-6900
Fax Number	:	718-296-0737

Provider Business Practice Location Address
First Line	:	8416 JAMAICA AVE
Second Line	:
City	:	WOODHAVEN
State	:	NY
Zip	:	11421-1920
Country	:	US
Telephone Number	:	718-296-6900
Fax Number	:	718-296-0737

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	02/21/2013

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