MEDICARE: MRS. SHARYL BRONSKY-LEDERMAN P.T.

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	008476-1	NY
2	2251P0200X	Pediatric Physical Therapist	008476-1	NY

General Provider Information

NPI Number	:	1164667556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARYL BRONSKY-LEDERMAN P.T.

Provider Business Mailing Address
First Line	:	500 E 77TH ST
Second Line	:	APT. 2719
City	:	NEW YORK
State	:	NY
Zip	:	10162-0025
Country	:	US
Telephone Number	:	212-734-4110
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E 77TH ST
Second Line	:	APT. 2719
City	:	NEW YORK
State	:	NY
Zip	:	10162-0025
Country	:	US
Telephone Number	:	212-734-4110
Fax Number	:

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

Provider Enumeration Date	:	12/13/2008
Last Update Date	:	12/13/2008

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