MEDICARE: DR. MARIO CHIARIELLO MD

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	208600000X	Surgery Physician	145387	NY

General Provider Information

NPI Number	:	1851395123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO CHIARIELLO MD

Provider Business Mailing Address
First Line	:	1479 73RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2111
Country	:	US
Telephone Number	:	718-331-4938
Fax Number	:	718-621-3906

Provider Business Practice Location Address
First Line	:	1479 73RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2111
Country	:	US
Telephone Number	:	718-331-4938
Fax Number	:	718-621-3906

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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