MEDICARE: MR. JOSEPH ANTHONY VEGA MS PT, CSCS

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	027285	NY
2	174400000X	Specialist	200528295	NY

General Provider Information

NPI Number	:	1184688780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH ANTHONY VEGA MS PT, CSCS

Provider Business Mailing Address
First Line	:	144 W 23RD ST
Second Line	:	APARTMENT PH F
City	:	NEW YORK
State	:	NY
Zip	:	10011-9401
Country	:	US
Telephone Number	:	347-306-3357
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 W 25TH ST
Second Line	:	2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10001-7400
Country	:	US
Telephone Number	:	347-306-3357
Fax Number	:

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	05/26/2014

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