MEDICARE: DELEO FAMILY MEDICINE P 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1770867780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELEO FAMILY MEDICINE P C

Provider Business Mailing Address
First Line	:	145 SAWKILL RD
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-1226
Country	:	US
Telephone Number	:	845-853-7003
Fax Number	:	845-853-7002

Provider Business Practice Location Address
First Line	:	145 SAWKILL RD
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-1226
Country	:	US
Telephone Number	:	845-853-7003
Fax Number	:	845-853-7002

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PAM PARMELEE
Credential	:
Telephone Number	:	845-853-7003

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	11/30/2011

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