MEDICARE: MAGGIE ELMARDENLY 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

General Provider Information

NPI Number	:	1164018156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGGIE ELMARDENLY DPT

Provider Business Mailing Address
First Line	:	271 86TH ST APT 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 OCEAN PKWY APT 2G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8344
Country	:	US
Telephone Number	:	347-755-6686
Fax Number	:

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

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	12/14/2020

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