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General NPI Number Information
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NPI Number | 1538353115
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Entity Type | Individual
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Provider Name | JEFFERY AMERIGO TODESCO PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 163 AMSTERDAM AVE #293 OUTREACH PHYSICAL THERAPY
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City | NEW YORK
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State | NY
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Zip | 10023
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Country | US
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Telephone | 917-620-2171
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Fax |
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Provider Business Mailing Address
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Address Line | 100 37TH ST APT 14
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City | UNION CITY
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State | NJ
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Zip | 07087-6037
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Country | US
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Telephone | 917-678-1687
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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 | 029039-1
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License Number State | NY
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