MEDICARE: ROBERTO C. GRANATO, MDPC

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	208800000X	Urology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39563	OTHER	NY	GHI MEDICARE

General Provider Information

NPI Number	:	1750577615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTO C. GRANATO, MDPC

Provider Business Mailing Address
First Line	:	4046 75TH ST
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-1012
Country	:	US
Telephone Number	:	718-335-1437
Fax Number	:	718-899-1846

Provider Business Practice Location Address
First Line	:	4046 75TH ST
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-1012
Country	:	US
Telephone Number	:	718-335-1437
Fax Number	:	718-899-1846

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERTO C. GRANATO
Credential	:	MD
Telephone Number	:	718-335-1437

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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