MEDICARE: DGS NEUROLOGICAL PLLC

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	2084N0400X	Neurology Physician	240518	NY

General Provider Information

NPI Number	:	1790095289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DGS NEUROLOGICAL PLLC

Provider Business Mailing Address
First Line	:	1705 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-2817
Country	:	US
Telephone Number	:	877-581-3390
Fax Number	:

Provider Business Practice Location Address
First Line	:	4982 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-6399
Country	:	US
Telephone Number	:	877-581-3390
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIELLE GERALDI-SAMARA
Credential	:	M.D.
Telephone Number	:	877-581-3390

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	10/18/2010

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