=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063021335
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET E O'NEIL PT, PHD, MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2020
-----------------------------------------------------
Last Update Date | 07/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 FORT WASHINGTON ST HARKNESS 1-164
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-8020
-----------------------------------------------------
Fax | 212-305-4356
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 617 W 168TH ST STE 3-333
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-3925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-6991
-----------------------------------------------------
Fax | 212-305-4569
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | 045003-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------