MEDICARE: MR. GARY ALAN FALCETANO PA-C

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	25MP00044300	NJ

General Provider Information

NPI Number	:	1972586642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY ALAN FALCETANO PA-C

Provider Business Mailing Address
First Line	:	4 EDNA HORN DR
Second Line	:
City	:	STOCKTON
State	:	NJ
Zip	:	08559-1401
Country	:	US
Telephone Number	:	609-773-0559
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 EDNA HORN DR
Second Line	:
City	:	STOCKTON
State	:	NJ
Zip	:	08559-1401
Country	:	US
Telephone Number	:	609-773-0559
Fax Number	:

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

Provider Enumeration Date	:	11/27/2005
Last Update Date	:	10/01/2012

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