MEDICARE: F PACIFICO PC

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	207R00000X	Internal Medicine Physician	141745	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871776435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	F PACIFICO PC

Provider Business Mailing Address
First Line	:	60 QUEENS ST
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-3058
Country	:	US
Telephone Number	:	718-702-7216
Fax Number	:	831-603-0351

Provider Business Practice Location Address
First Line	:	60 QUEENS ST
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-3058
Country	:	US
Telephone Number	:	718-702-7216
Fax Number	:	831-603-0351

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FERNANDO PACIFICO
Credential	:	M.D.
Telephone Number	:	718-702-7216

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	04/27/2022

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Directions to “F PACIFICO PC ” Practice Location

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