MEDICARE: DR. MARINA SKUTELSKY D.D.S

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	1223G0001X	General Practice Dentistry	033533	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

General Provider Information

NPI Number	:	1750371464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARINA SKUTELSKY D.D.S

Provider Business Mailing Address
First Line	:	9229 QUEENS BLVD
Second Line	:	SUITE 1E
City	:	REGO PARK
State	:	NY
Zip	:	11374-1056
Country	:	US
Telephone Number	:	718-268-8225
Fax Number	:

Provider Business Practice Location Address
First Line	:	9229 QUEENS BLVD
Second Line	:	SUITE 1E
City	:	REGO PARK
State	:	NY
Zip	:	11374-1056
Country	:	US
Telephone Number	:	718-268-8225
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/08/2007

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