MEDICARE: CZARISSA ESPANOL CASALME

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	044199-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	044199-1	OTHER	NY	STATE LICENSE

General Provider Information

NPI Number	:	1336788421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CZARISSA ESPANOL CASALME

Provider Business Mailing Address
First Line	:	201 SAINT NICHOLAS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4840
Country	:	US
Telephone Number	:	718-821-9511
Fax Number	:	718-889-2378

Provider Business Practice Location Address
First Line	:	201 SAINT NICHOLAS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4840
Country	:	US
Telephone Number	:	718-821-9511
Fax Number	:	718-889-2378

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

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	01/06/2020

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Directions to “ CZARISSA ESPANOL CASALME ” Practice Location

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