MEDICARE: PISCIOTTO AND PISCIOTTO MEDICAL P C

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		NY

General Provider Information

NPI Number	:	1609146885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PISCIOTTO AND PISCIOTTO MEDICAL P C

Provider Business Mailing Address
First Line	:	6835 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7234
Country	:	US
Telephone Number	:	718-386-9876
Fax Number	:	718-628-0108

Provider Business Practice Location Address
First Line	:	6835 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7234
Country	:	US
Telephone Number	:	718-386-9876
Fax Number	:	718-628-0108

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SALVATORE PISCIOTTO
Credential	:	D. O.
Telephone Number	:	718-386-9876

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	01/05/2012

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