MEDICARE: NICHOLAS POSILLICO 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	0151101	NY
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1750395158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS POSILLICO PT

Provider Business Mailing Address
First Line	:	1590 UNION BLVD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706
Country	:	US
Telephone Number	:	631-665-2421
Fax Number	:	631-665-3416

Provider Business Practice Location Address
First Line	:	1590 UNION BLVD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706
Country	:	US
Telephone Number	:	631-665-2421
Fax Number	:	631-665-3416

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	06/11/2008

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