MEDICARE: MARK ANDY OPFER 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
1	225100000X	Physical Therapist	025267-1

General Provider Information

NPI Number	:	1396846556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ANDY OPFER PT

Provider Business Mailing Address
First Line	:	75 MAIDEN LN
Second Line	:	SUITE 801
City	:	NEW YORK
State	:	NY
Zip	:	10038-4810
Country	:	US
Telephone Number	:	646-312-6221
Fax Number	:	212-269-2905

Provider Business Practice Location Address
First Line	:	745 7TH AVE
Second Line	:	21ST FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10019-6801
Country	:	US
Telephone Number	:	646-312-6288
Fax Number	:	212-269-2905

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/26/2011

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Directions to “ MARK ANDY OPFER PT” Practice Location

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