MEDICARE: MR. ANGELO ZEGARELLI ATC, CSCS

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	2255A2300X	Athletic Trainer	000197	NY

General Provider Information

NPI Number	:	1578526778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANGELO ZEGARELLI ATC, CSCS

Provider Business Mailing Address
First Line	:	1163 GOERGEN ATHLETIC CENTER
Second Line	:	UNIVERSITY OF ROCHESTER
City	:	ROCHESTER
State	:	NY
Zip	:	14627
Country	:	US
Telephone Number	:	585-273-3630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1163 GOERGEN ATHLETIC CENTER
Second Line	:	UNIVERSITY OF ROCHESTER
City	:	ROCHESTER
State	:	NY
Zip	:	14627
Country	:	US
Telephone Number	:	585-273-3630
Fax Number	:

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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