Healthcare Provider Details

I. General information

NPI: 1104878651
Provider Name (Legal Business Name): CHARLES MORANO PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 VANDERBILT AVE SUITE 1413
NEW YORK NY
10017-3808
US

IV. Provider business mailing address

200 PARK AVE GROUND FL.
NEW YORK NY
10166-0005
US

V. Phone/Fax

Practice location:
  • Phone: 212-599-0099
  • Fax: 212-599-0389
Mailing address:
  • Phone: 212-953-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023254-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: