MEDICARE: CARL G SCEUSA MD

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	207R00000X	Internal Medicine Physician	170950	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	1720190259	OTHER	NY	NPI

General Provider Information

NPI Number	:	1720190259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL G SCEUSA MD

Provider Business Mailing Address
First Line	:	1550 RICHMOND AVE
Second Line	:	SUITE 202
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1578
Country	:	US
Telephone Number	:	718-370-7700
Fax Number	:	718-370-7798

Provider Business Practice Location Address
First Line	:	1550 RICHMOND AVE
Second Line	:	SUITE 202
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1578
Country	:	US
Telephone Number	:	718-370-7700
Fax Number	:	718-370-7798

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/03/2010

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Directions to “ CARL G SCEUSA MD” Practice Location

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