MEDICARE: MILAN DESAMITO 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	050107	NY

General Provider Information

NPI Number	:	1174223051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILAN DESAMITO DPT

Provider Business Mailing Address
First Line	:	126 SAINT MARKS PL APT 18
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-5867
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 SAINT MARKS PL APT 18
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-5867
Country	:	US
Telephone Number	:	714-290-0670
Fax Number	:

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

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	03/08/2023

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Directions to “ MILAN DESAMITO DPT” Practice Location

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