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General NPI Number Information
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NPI Number | 1326299371
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Entity Type | Organization
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Legal Business Name | TAMAYO PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 10/08/2008
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 30 E 65TH ST SUITE 4A
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City | NEW YORK
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State | NY
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Zip | 10065-7013
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Country | US
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Telephone | 212-535-2621
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Fax |
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Provider Business Mailing Address
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Address Line | 354 RUSSELL AVE
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City | EDGEWATER
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State | NJ
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Zip | 07020-3133
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Country | US
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Telephone | 646-977-9548
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GEZEL TAMAYO VILLANUEVA-FISCHBERG
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Credential | MS, PT
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Telephone | 646-977-9548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 010519-1
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License Number State | NY
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