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General NPI Number Information
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NPI Number | 1417149345
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Entity Type | Individual
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Provider Name | OLIVER TELLO MS, PT
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Gender | Male
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 22A MERRICK AVE
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City | MERRICK
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State | NY
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Zip | 11566-3490
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Country | US
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Telephone | 917-295-1025
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Fax |
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Provider Business Mailing Address
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Address Line | 16 CLAFLIN BLVD
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-4315
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Country | US
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Telephone | 516-214-4848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 028657-1
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License Number State | NY
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