MEDICARE: MR. JOSEPH C PETER P.T.

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	023366	NY

General Provider Information

NPI Number	:	1053384768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH C PETER P.T.

Provider Business Mailing Address
First Line	:	2560 CEDAR ST
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-2112
Country	:	US
Telephone Number	:	516-731-4505
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 NEPTUNE AVE
Second Line	:	LOBBY
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4063
Country	:	US
Telephone Number	:	718-513-0295
Fax Number	:	718-513-0296

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

Provider Enumeration Date	:	02/12/2006
Last Update Date	:	04/19/2010

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