MEDICARE: MRS. ELIZABETH ANN RAGO

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	174400000X	Specialist	848763	NY

General Provider Information

NPI Number	:	1821343443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANN RAGO

Provider Business Mailing Address
First Line	:	237 SEARS RD
Second Line	:
City	:	WEST ISLIP
State	:	NY
Zip	:	11795-2918
Country	:	US
Telephone Number	:	631-334-3772
Fax Number	:

Provider Business Practice Location Address
First Line	:	237 SEARS RD
Second Line	:
City	:	WEST ISLIP
State	:	NY
Zip	:	11795-2918
Country	:	US
Telephone Number	:	631-334-3772
Fax Number	:

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

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	07/19/2012

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