MEDICARE: DANIEL JOSEPH ROOTENBERG MS, PT

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	2251X0800X	Orthopedic Physical Therapist	017761	NY

General Provider Information

NPI Number	:	1093876880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JOSEPH ROOTENBERG MS, PT

Provider Business Mailing Address
First Line	:	120 E 56TH ST
Second Line	:	STE 1010
City	:	NEW YORK
State	:	NY
Zip	:	10022-3607
Country	:	US
Telephone Number	:	212-759-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 E 56TH ST
Second Line	:	STE 1010
City	:	NEW YORK
State	:	NY
Zip	:	10022-3607
Country	:	US
Telephone Number	:	212-759-2211
Fax Number	:

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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