MEDICARE: MR. MATTHEW P LINADO B.A.

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	174400000X	Specialist	544758	NY

General Provider Information

NPI Number	:	1699025627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW P LINADO B.A.

Provider Business Mailing Address
First Line	:	112 SOUTHAVEN AVE
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-3739
Country	:	US
Telephone Number	:	631-289-6860
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 SOUTHAVEN AVE
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-3739
Country	:	US
Telephone Number	:	631-289-6860
Fax Number	:

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

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	09/18/2012

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