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NPI Code Detail

MEDICARE: ELEANOR O'CONNELL PTA

MEDICARE: ELEANOR O'CONNELL PTA
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
1225200000XPhysical Therapy Assistant005606NY

General Provider Information

NPI Number : 1235781790
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELEANOR O'CONNELL PTA
Provider Business Mailing Address
First Line : 1565 E 36TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-3415
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1716 CONEY ISLAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-5801
Country : US
Telephone Number : 718-336-4900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2019
Last Update Date : 07/15/2019

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