MEDICARE: DR. LAURENE TRICIA IAMMATTEO D.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	111N00000X	Chiropractor	X008087-1	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	:	1609963206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURENE TRICIA IAMMATTEO D.C.

Provider Business Mailing Address
First Line	:	1332 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2002
Country	:	US
Telephone Number	:	718-442-8813
Fax Number	:	718-876-0158

Provider Business Practice Location Address
First Line	:	1332 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2002
Country	:	US
Telephone Number	:	718-442-8813
Fax Number	:	718-876-0158

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. LAURENE TRICIA IAMMATTEO D.C.” Practice Location

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