MEDICARE: VERRAZANO PHYSICAL THERAPY PC

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	0144721	NY
2	225100000X	Physical Therapist	0140801	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1528019197	OTHER	NY	PROVIDER NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1851343016	OTHER	NY	PROVIDER NPI

General Provider Information

NPI Number	:	1912112566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERRAZANO PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	6911 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-1101
Country	:	US
Telephone Number	:	718-630-1290
Fax Number	:	718-630-1291

Provider Business Practice Location Address
First Line	:	6911 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-1101
Country	:	US
Telephone Number	:	718-630-1290
Fax Number	:	718-630-1291

Authorized Official
Title or Position	:	DR.
Name	:	DR. BAYOMY A MOUSTAFA
Credential	:	P.T
Telephone Number	:	718-630-1290

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	06/15/2009

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Directions to “VERRAZANO PHYSICAL THERAPY PC ” Practice Location

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