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General NPI Number Information
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NPI Number | 1518401744
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Entity Type | Individual
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Provider Name | KERLOS AMMONIUS PT
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Gender | Male
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 8002 KEW GARDENS RD FL 4
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City | KEW GARDENS
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State | NY
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Zip | 11415-3604
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Country | US
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Telephone | 718-263-7500
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Fax | 718-263-7502
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Provider Business Mailing Address
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Address Line | 576 BROADHOLLOW RD
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City | MELVILLE
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State | NY
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Zip | 11747-5002
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Country | US
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Telephone | 631-359-5856
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Fax | 631-396-0865
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 037321-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 037321
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License Number State | NY
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