=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114167871
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXIS PASTERA PENAFLORIDA PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2009
-----------------------------------------------------
Last Update Date | 12/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 BROAD STREET SUITE #15F DOWNTOWN SPINE SPORTS & ORTHOPEDIC REHABILI
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-422-1111
-----------------------------------------------------
Fax | 212-867-2255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX #4447 DOWNTOWN SPINE SPORTS & ORTHOPEDIC REHABILITATION PC
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-422-1111
-----------------------------------------------------
Fax | 212-867-2255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 023679
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 023679
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------