MEDICARE: MR. ALFRED CLAYTON BANNERMAN M.D.

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	2084N0400X	Neurology Physician	111142	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649231366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALFRED CLAYTON BANNERMAN M.D.

Provider Business Mailing Address
First Line	:	180 SALEM ROAD
Second Line	:
City	:	WESTBURY
State	:	NY
Zip	:	11590
Country	:	US
Telephone Number	:	516-997-3269
Fax Number	:

Provider Business Practice Location Address
First Line	:	8900 VAN WYCK EXPRESSWAY
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11418-2832
Country	:	US
Telephone Number	:	718-206-7089
Fax Number	:	718-206-7055

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	11/25/2014

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Directions to “ MR. ALFRED CLAYTON BANNERMAN M.D.” Practice Location

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