MEDICARE: MR. SAVINO DAGOSTINO

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	156FX1800X	Optician	5126	NY

General Provider Information

NPI Number	:	1730468034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAVINO DAGOSTINO

Provider Business Mailing Address
First Line	:	1402 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3408
Country	:	US
Telephone Number	:	718-331-1010
Fax Number	:	718-331-1095

Provider Business Practice Location Address
First Line	:	1402 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3408
Country	:	US
Telephone Number	:	718-331-1010
Fax Number	:	718-331-1095

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

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	08/04/2011

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