MEDICARE: MARIA ANGELICA FAYLOGA JAPOS

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	040145	NY

General Provider Information

NPI Number	:	1437664224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ANGELICA FAYLOGA JAPOS

Provider Business Mailing Address
First Line	:	15-17 WILLETS ST
Second Line	:	1G
City	:	NEW YORK
State	:	NY
Zip	:	10002
Country	:	US
Telephone Number	:	929-219-7490
Fax Number	:

Provider Business Practice Location Address
First Line	:	1072 HAVEMEYER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5310
Country	:	US
Telephone Number	:	718-863-6200
Fax Number	:

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

Provider Enumeration Date	:	12/03/2017
Last Update Date	:	12/03/2017

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