MEDICARE: PAOLI MEDICAL EYECARE,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	207W00000X	Ophthalmology Physician	148384	NY

General Provider Information

NPI Number	:	1629045257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAOLI MEDICAL EYECARE,P.C.

Provider Business Mailing Address
First Line	:	300 FORT WASHINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-1323
Country	:	US
Telephone Number	:	212-928-1498
Fax Number	:	212-928-1670

Provider Business Practice Location Address
First Line	:	300 FORT WASHINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-1323
Country	:	US
Telephone Number	:	212-928-1498
Fax Number	:	212-928-1670

Authorized Official
Title or Position	:	OWNER
Name	:	GLORIA PAOLI
Credential	:	MD
Telephone Number	:	212-928-1498

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	02/15/2008

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