MEDICARE: OVINGTON ORTHOPEDIC MEDICINE ASSOCIATES LLC

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1841201621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OVINGTON ORTHOPEDIC MEDICINE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	6900 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1502
Country	:	US
Telephone Number	:	718-238-6400
Fax Number	:	718-238-1305

Provider Business Practice Location Address
First Line	:	6900 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1502
Country	:	US
Telephone Number	:	718-238-6400
Fax Number	:	718-238-1305

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH FELICCIA
Credential	:	M.D.
Telephone Number	:	718-239-6400

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	09/07/2007

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