MEDICARE: MR. JOSEPH D. LAVACCA DPT

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	032843-1	NY

General Provider Information

NPI Number	:	1083928444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH D. LAVACCA DPT

Provider Business Mailing Address
First Line	:	584 BROADWAY
Second Line	:	SUITE 710
City	:	NEW YORK
State	:	NY
Zip	:	10012-5242
Country	:	US
Telephone Number	:	212-941-0503
Fax Number	:	212-941-6195

Provider Business Practice Location Address
First Line	:	584 BROADWAY
Second Line	:	SUITE 710
City	:	NEW YORK
State	:	NY
Zip	:	10012-5242
Country	:	US
Telephone Number	:	212-941-0503
Fax Number	:	212-941-6195

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

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	03/12/2018

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