MEDICARE: EDWARD W KALTEN JR. 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	021499	NY

General Provider Information

NPI Number	:	1932125689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD W KALTEN JR. PT

Provider Business Mailing Address
First Line	:	206 N IOWA AVE
Second Line	:
City	:	N MASSAPEQUA
State	:	NY
Zip	:	11758-1323
Country	:	US
Telephone Number	:	516-293-8224
Fax Number	:	631-328-5921

Provider Business Practice Location Address
First Line	:	53 BRENTWOOD RD
Second Line	:	SUITE B
City	:	BAY SHORE
State	:	NY
Zip	:	11706-6923
Country	:	US
Telephone Number	:	631-328-5920
Fax Number	:	631-328-5921

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	02/05/2009

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