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General NPI Number Information
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NPI Number | 1639886526
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Entity Type | Individual
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Provider Name | TYLER ROSS MOLDOFF DPT
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Gender | Male
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Dates
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Enumeration Date | 11/01/2022
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 770 LEXINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10065-8165
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Country | US
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Telephone | 646-618-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 196 WALLINGTON AVE
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City | WALLINGTON
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State | NJ
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Zip | 07057-1226
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Country | US
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Telephone | 201-600-1855
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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 |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State | NY
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