MEDICARE: TRIBORO CARE PT PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	027797	NY

General Provider Information

NPI Number	:	1013104686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIBORO CARE PT PC

Provider Business Mailing Address
First Line	:	235 SHERIDAN BLVD
Second Line	:
City	:	MINEOLA
State	:	NY
Zip	:	11501-3220
Country	:	US
Telephone Number	:	718-940-2100
Fax Number	:	718-940-1336

Provider Business Practice Location Address
First Line	:	353 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1308
Country	:	US
Telephone Number	:	718-940-2100
Fax Number	:	718-940-1336

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GEORGE FAWZI TAWDROS
Credential	:	PT
Telephone Number	:	212-686-6700

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	09/27/2007

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Directions to “TRIBORO CARE PT PC ” Practice Location

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