MEDICARE: MRS. NENITA HIPOLITO PESCADOR II

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	225100000X	Physical Therapist	031147	NY

General Provider Information

NPI Number	:	1073337903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NENITA HIPOLITO PESCADOR II

Provider Business Mailing Address
First Line	:	1345 AVENUE OF THE AMERICAS FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10105-0008
Country	:	US
Telephone Number	:	212-981-1977
Fax Number	:	646-786-4026

Provider Business Practice Location Address
First Line	:	1345 AVENUE OF THE AMERICAS FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10105-0008
Country	:	US
Telephone Number	:	212-981-1977
Fax Number	:	646-786-4026

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

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	11/07/2024

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