Healthcare Provider Details

I. General information

NPI: 1376278234
Provider Name (Legal Business Name): GIORLAN SOSOSCO OLVIDO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 67TH ST
WOODSIDE NY
11377-8525
US

IV. Provider business mailing address

4020 67TH ST
WOODSIDE NY
11377-8525
US

V. Phone/Fax

Practice location:
  • Phone: 646-387-0769
  • Fax:
Mailing address:
  • Phone: 646-387-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number046392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: