MEDICARE: A.FEUEREISEN &L. SZANTO PTR

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	314000000X	Skilled Nursing Facility	7003315N	NY

General Provider Information

NPI Number	:	1639167935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A.FEUEREISEN &L. SZANTO PTR

Provider Business Mailing Address
First Line	:	1311 VIRGINIA ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4630
Country	:	US
Telephone Number	:	718-327-2909
Fax Number	:	718-327-7504

Provider Business Practice Location Address
First Line	:	13-11 VIRGINIA STREET
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4630
Country	:	US
Telephone Number	:	718-327-2909
Fax Number	:	718-327-7504

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ARON FEUEREISEN
Credential	:
Telephone Number	:	718-327-2909

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	06/20/2008

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