MEDICARE: GERALD DIMASO 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	261QP2300X	Primary Care Clinic/Center	170623	NY

General Provider Information

NPI Number	:	1760777486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERALD DIMASO MDPC

Provider Business Mailing Address
First Line	:	69 SEGUINE AVENUE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309
Country	:	US
Telephone Number	:	718-356-6500
Fax Number	:	718-356-0348

Provider Business Practice Location Address
First Line	:	68 SEGUINE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3723
Country	:	US
Telephone Number	:	718-356-6500
Fax Number	:	718-356-0348

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GERALD GENNARO DIMASO
Credential	:	MD
Telephone Number	:	718-356-6500

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	06/10/2011

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