=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831429349
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROMAN NOLASCO TAN PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2010
-----------------------------------------------------
Last Update Date | 01/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 81 ELIZABETH ST STE 602
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-4729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-219-9262
-----------------------------------------------------
Fax | 212-219-9263
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 81 ELIZABETH ST STE 602
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-4729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-219-9262
-----------------------------------------------------
Fax | 212-219-9263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 021186-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------