MEDICARE: DR. MARIE E. DEGIACOMO D.C.

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	111N00000X	Chiropractor	X3327	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00177779	OTHER	NY	PTAN/PALMETTO GBA

General Provider Information

NPI Number	:	1760576995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE E. DEGIACOMO D.C.

Provider Business Mailing Address
First Line	:	8114 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3804
Country	:	US
Telephone Number	:	718-238-5120
Fax Number	:	718-238-5129

Provider Business Practice Location Address
First Line	:	8114 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3804
Country	:	US
Telephone Number	:	718-238-5120
Fax Number	:	718-238-5129

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	12/12/2007

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