MEDICARE: LANCE ELLIOT CHERRY MPT

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	225100000X	Physical Therapist	012671	NY

General Provider Information

NPI Number	:	1043232234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE ELLIOT CHERRY MPT

Provider Business Mailing Address
First Line	:	230 E 50TH ST
Second Line	:	APT. 5A
City	:	NEW YORK
State	:	NY
Zip	:	10022-7682
Country	:	US
Telephone Number	:	212-750-0460
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 IRVING PL
Second Line	:	9TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10003-2332
Country	:	US
Telephone Number	:	212-677-3989
Fax Number	:	212-677-3994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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Directions to “ LANCE ELLIOT CHERRY MPT” Practice Location

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