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NPI Code Detail

MEDICARE: MR. MICHAEL MASARACCHIO P.T.

MEDICARE: MR. MICHAEL MASARACCHIO 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
1225100000XPhysical Therapist023348-1NY

General Provider Information

NPI Number : 1265448567
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL MASARACCHIO P.T.
Provider Business Mailing Address
First Line : 1672 73RD ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11204-5122
Country : US
Telephone Number : 718-833-7873
Fax Number : 718-232-5048
Provider Business Practice Location Address
First Line : 7608 15TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11228-2510
Country : US
Telephone Number : 718-259-0900
Fax Number : 718-232-5048
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 07/08/2007

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