MEDICARE: ARIEL TANIAJURA 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	019212-1	NY

General Provider Information

NPI Number	:	1518524685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL TANIAJURA PT

Provider Business Mailing Address
First Line	:	8914 SPRINGFIELD BLVD
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-2514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8914 SPRINGFIELD BLVD
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-2514
Country	:	US
Telephone Number	:	917-478-5599
Fax Number	:

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

Provider Enumeration Date	:	05/23/2019
Last Update Date	:	05/23/2019

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