MEDICARE: LLOYD MAQUILING RPT

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	027095	NY

General Provider Information

NPI Number	:	1518584358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LLOYD MAQUILING RPT

Provider Business Mailing Address
First Line	:	67 CENTRE AVENUE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304
Country	:	US
Telephone Number	:	917-916-0949
Fax Number	:

Provider Business Practice Location Address
First Line	:	198 OLD BERGEN RD #2622
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305
Country	:	US
Telephone Number	:	888-560-5995
Fax Number	:

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

Provider Enumeration Date	:	06/27/2020
Last Update Date	:	06/27/2020

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