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General NPI Number Information
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NPI Number | 1679698484
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Entity Type | Individual
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Provider Name | FARA DESFOR LE BRETON PT, MSC, MACP
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30 W 57TH ST 6TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10019-3916
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Country | US
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Telephone | 212-317-9798
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Fax |
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Provider Business Mailing Address
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Address Line | 119 W 71ST ST #5A
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City | NEW YORK
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State | NY
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Zip | 10023-3876
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Country | US
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Telephone |
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 016820-1
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License Number State | NY
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