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General NPI Number Information
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NPI Number | 1396117628
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Entity Type | Organization
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Legal Business Name | FERNANDO MORENO PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 6050 KENNEDY BLVD E APT 2G
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-3901
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Country | US
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Telephone | 917-306-0725
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Fax |
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Provider Business Mailing Address
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Address Line | 6050 KENNEDY BLVD E APT 2G
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-3901
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Country | US
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Telephone | 917-306-0725
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | FERNANDO MORENO JR.
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Credential | DPT
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Telephone | 917-306-0725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 036219
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40QA015352001
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License Number State | NJ
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