MEDICARE: MR. JOHN MARCOS ANGELES 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	23997	NY

General Provider Information

NPI Number	:	1881787117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MARCOS ANGELES PT

Provider Business Mailing Address
First Line	:	334 FOSTER AVE
Second Line	:	APT B7
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL
Second Line	:	MC LEVEL, BOX 1241
City	:	NEW YORK
State	:	NY
Zip	:	10029-6500
Country	:	US
Telephone Number	:	212-241-8045
Fax Number	:

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

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	07/08/2007

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