MEDICARE: MARIA LOURDES DEL MUNDO

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	028458	NY

General Provider Information

NPI Number	:	1043521032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA LOURDES DEL MUNDO

Provider Business Mailing Address
First Line	:	92-31 55TH AVENUE
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4951 CHAMBERS STREET 6TH FLOOR
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-1209
Country	:	US
Telephone Number	:	352-233-0273
Fax Number	:

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

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	06/24/2010

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