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NPI Code Detail

MEDICARE: MRS. SUMA MARIAM KURIAKOSE PT

MEDICARE: MRS. SUMA MARIAM KURIAKOSE PT
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 Therapist031115NY

General Provider Information

NPI Number : 1306086707
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUMA MARIAM KURIAKOSE PT
Provider Business Mailing Address
First Line : 289 GANSEVOORT BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-5105
Country : US
Telephone Number : 718-983-0366
Fax Number :
Provider Business Practice Location Address
First Line : 25 FANNING ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-5307
Country : US
Telephone Number : 718-289-7019
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2009
Last Update Date : 02/24/2009

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