MEDICARE: MR. FABIO MURILLO LAC

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	171100000X	Acupuncturist	005474	NY

General Provider Information

NPI Number	:	1801319702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FABIO MURILLO LAC

Provider Business Mailing Address
First Line	:	15 CANDY LN
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-4909
Country	:	US
Telephone Number	:	516-852-1821
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 GLEN ST STE 380
Second Line	:
City	:	GLEN COVE
State	:	NY
Zip	:	11542-2858
Country	:	US
Telephone Number	:	516-852-1821
Fax Number	:

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

Provider Enumeration Date	:	07/23/2017
Last Update Date	:	07/23/2017

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