MEDICARE: ELEAZAR VILORIA INCABO 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
1	225100000X	Physical Therapist	020160	NY

General Provider Information

NPI Number	:	1477520765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEAZAR VILORIA INCABO P.T.

Provider Business Mailing Address
First Line	:	00146 TUNBRIDGE RD
Second Line	:
City	:	FAIR LAWN
State	:	NJ
Zip	:	07410-5404
Country	:	US
Telephone Number	:	201-475-5606
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 MEDICAL PARK DR
Second Line	:	SUITE 104
City	:	POMONA
State	:	NY
Zip	:	10970-3559
Country	:	US
Telephone Number	:	845-354-6700
Fax Number	:

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

Provider Enumeration Date	:	03/05/2006
Last Update Date	:	06/18/2013

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