MEDICARE: NYSSPT, INC.

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	2251X0800X	Orthopedic Physical Therapist	026668-1	NY

General Provider Information

NPI Number	:	1972892446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYSSPT, INC.

Provider Business Mailing Address
First Line	:	1829 HOBART AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-4117
Country	:	US
Telephone Number	:	347-810-7637
Fax Number	:	347-810-7638

Provider Business Practice Location Address
First Line	:	1829 HOBART AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-4117
Country	:	US
Telephone Number	:	347-810-7637
Fax Number	:	347-810-7638

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KARN SANTIKUL
Credential	:	DPT
Telephone Number	:	347-810-7637

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2011

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