MEDICARE: ROUTE 22 MEDICAL PC

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	207R00000X	Internal Medicine Physician	203453	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	:	1578643276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROUTE 22 MEDICAL PC

Provider Business Mailing Address
First Line	:	1591 ROUTE 22
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509
Country	:	US
Telephone Number	:	845-278-8797
Fax Number	:	845-278-8798

Provider Business Practice Location Address
First Line	:	1591 ROUTE 22
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-4026
Country	:	US
Telephone Number	:	845-278-8797
Fax Number	:	845-278-8798

Authorized Official
Title or Position	:	PRACTITIONER
Name	:	LUIGIA GINA NOTARISTEFANO
Credential	:	MD
Telephone Number	:	845-278-8797

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/18/2008

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Directions to “ROUTE 22 MEDICAL PC ” Practice Location

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