MEDICARE: CARLA LYNN SANGIORGIO

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	320700000X	Physical Disabilities Residential Treatment Facility	671937	NY

General Provider Information

NPI Number	:	1932520129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLA LYNN SANGIORGIO

Provider Business Mailing Address
First Line	:	1080 RENSSELAER AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-2114
Country	:	US
Telephone Number	:	718-227-2466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1080 RENSSELAER AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-2114
Country	:	US
Telephone Number	:	718-227-2466
Fax Number	:

Authorized Official
Title or Position	:	RN NURSE
Name	:	MS. CARLA LYNN SANGIORGIO
Credential	:	R.N
Telephone Number	:	718-227-2466

Provider Enumeration Date	:	12/15/2013
Last Update Date	:	12/15/2013

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