MEDICARE: MS. CONSOLACION OBEDO ESTRELLA 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	018236	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	018236	OTHER	NY	HIP
2	11303	OTHER	NY	MAGNACARE
3	2234571	OTHER	NY	FIRST HEALTH
4	9525118	OTHER	NY	CIGNA
5	2439101	OTHER	NY	UNITED HEALTHCARE
6	6697223	OTHER	NY	GHI

General Provider Information

NPI Number	:	1538169735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONSOLACION OBEDO ESTRELLA PT

Provider Business Mailing Address
First Line	:	787 LYDIG AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-2144
Country	:	US
Telephone Number	:	718-863-7774
Fax Number	:	718-792-0288

Provider Business Practice Location Address
First Line	:	787 LYDIG AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-2144
Country	:	US
Telephone Number	:	718-863-7774
Fax Number	:	718-792-0288

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/09/2007

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