MEDICARE: DR. MARTA DINORA CANALES 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	208000000X	Pediatrics Physician	215758	NY

General Provider Information

NPI Number	:	1750372843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTA DINORA CANALES MD

Provider Business Mailing Address
First Line	:	2075 MAPLE ST
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2516
Country	:	US
Telephone Number	:	516-771-4582
Fax Number	:

Provider Business Practice Location Address
First Line	:	2167 GRAND AVE
Second Line	:	1F
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2918
Country	:	US
Telephone Number	:	516-771-4582
Fax Number	:	516-771-4583

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

Provider Enumeration Date	:	10/29/2005
Last Update Date	:	07/08/2007

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