MEDICARE: NICHOLAS LUKE PANTALEO MD

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	207Q00000X	Family Medicine Physician	254722	NY

General Provider Information

NPI Number	:	1619299526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS LUKE PANTALEO MD

Provider Business Mailing Address
First Line	:	13303 JAMAICA AVE
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11418-2618
Country	:	US
Telephone Number	:	718-206-6914
Fax Number	:

Provider Business Practice Location Address
First Line	:	13303 JAMAICA AVE
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11418-2618
Country	:	US
Telephone Number	:	718-206-6914
Fax Number	:

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

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	06/29/2011

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