MEDICARE: DR. DARLENZY DARBOUZE 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	225100000X	Physical Therapist	031590	NY

General Provider Information

NPI Number	:	1770800880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARLENZY DARBOUZE DPT

Provider Business Mailing Address
First Line	:	95 WALL ST
Second Line	:	1004
City	:	NEW YORK
State	:	NY
Zip	:	10005-4201
Country	:	US
Telephone Number	:	917-977-1550
Fax Number	:	800-635-2303

Provider Business Practice Location Address
First Line	:	95 WALL ST
Second Line	:	1004
City	:	NEW YORK
State	:	NY
Zip	:	10005-4201
Country	:	US
Telephone Number	:	917-977-1550
Fax Number	:	800-635-2303

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

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	06/24/2010

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