MEDICARE: DR. CONCETTA FRANCES MACELI 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	1223P0300X	Periodontics	41478	NY

General Provider Information

NPI Number	:	1750480463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONCETTA FRANCES MACELI D.D.S.

Provider Business Mailing Address
First Line	:	45 ROUTE 25A
Second Line	:	SUITE E - 1
City	:	SHOREHAM
State	:	NY
Zip	:	11786-1389
Country	:	US
Telephone Number	:	631-744-6200
Fax Number	:	631-744-6387

Provider Business Practice Location Address
First Line	:	45 ROUTE 25A
Second Line	:	SUITE E - 1
City	:	SHOREHAM
State	:	NY
Zip	:	11786-1389
Country	:	US
Telephone Number	:	631-744-6200
Fax Number	:	631-744-6387

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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