MEDICARE: RINA GANELES

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	363A00000X	Physician Assistant	009637-1	NY

General Provider Information

NPI Number	:	1861784167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RINA GANELES

Provider Business Mailing Address
First Line	:	1115 PLAINVIEW AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-5519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7745
Country	:	US
Telephone Number	:	718-616-3257
Fax Number	:	718-616-3260

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

Provider Enumeration Date	:	05/05/2011
Last Update Date	:	05/05/2011

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Directions to “ RINA GANELES ” Practice Location

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