MEDICARE: LATO ASCIONE PHARMACY

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	013443	NY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3337688	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

NPI Number	:	1710998372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LATO ASCIONE PHARMACY

Provider Business Mailing Address
First Line	:	2268 1ST AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-5086
Country	:	US
Telephone Number	:	212-289-0811
Fax Number	:	212-289-6905

Provider Business Practice Location Address
First Line	:	2268 1ST AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-5086
Country	:	US
Telephone Number	:	212-289-0811
Fax Number	:	212-289-6905

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY CIARLETTA
Credential	:
Telephone Number	:	212-289-0811

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	03/12/2012

10 UNION SQ E , BETH ISRAEL MED CTR- DEPT OF REHAB MEDICARE
NEW YORK, NY
10003-3314

Practice Phone: 212-420-2757
Practice Fax: