MEDICARE: JAMES JOSEPH PT

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	026792	NY

General Provider Information

NPI Number	:	1083746234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES JOSEPH PT

Provider Business Mailing Address
First Line	:	3610 DITMARS BLVD
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11105-1919
Country	:	US
Telephone Number	:	516-263-5596
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10166-0005
Country	:	US
Telephone Number	:	212-953-9494
Fax Number	:	212-682-2013

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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Directions to “ JAMES JOSEPH PT” Practice Location

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