MEDICARE: ANNE ELIZABETH WATTERS DPT

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	208100000X	Physical Medicine & Rehabilitation Physician	036709	NY

General Provider Information

NPI Number	:	1598256042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE ELIZABETH WATTERS DPT

Provider Business Mailing Address
First Line	:	17 FLORENCE ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1592 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1529
Country	:	US
Telephone Number	:	347-857-6368
Fax Number	:

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

Provider Enumeration Date	:	05/21/2018
Last Update Date	:	05/21/2018

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