MEDICARE: MR. PASQUALE A BOMBINO BC-HIS

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	235500000X	Speech/Language/Hearing Specialist/Technologist	140000011010	NY

General Provider Information

NPI Number	:	1770685562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PASQUALE A BOMBINO BC-HIS

Provider Business Mailing Address
First Line	:	1670 E 17TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1258
Country	:	US
Telephone Number	:	718-627-2060
Fax Number	:	718-627-1951

Provider Business Practice Location Address
First Line	:	1670 E 17TH ST
Second Line	:	2A
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1258
Country	:	US
Telephone Number	:	718-627-2060
Fax Number	:	718-627-1951

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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