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NPI Code Detail

MEDICARE: MARILOU DYTIOCO

MEDICARE: MARILOU DYTIOCO
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
1225200000XPhysical Therapy Assistant006589NY

General Provider Information

NPI Number : 1578732376
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILOU DYTIOCO
Provider Business Mailing Address
First Line : 112 COLUMBIA AVE
Second Line :
City : DUMONT
State : NJ
Zip : 07628-3523
Country : US
Telephone Number : 646-824-9993
Fax Number :
Provider Business Practice Location Address
First Line : 6585 BROADWAY
Second Line :
City : BRONX
State : NY
Zip : 10471-2050
Country : US
Telephone Number : 718-549-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2008
Last Update Date : 02/26/2008

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Directions to “ MARILOU DYTIOCO ” Practice Location

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